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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7S-� ......... ... ......_....-----• - - ..... .. --�... (Complete in Triplicate) Permit No. ..................... This Permit Expires f Year From Date Issued Date Issued ..1:1...7.:.7S Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in complia ce with County Ordinance No. 544 and existing Rules and Regulations: M � Q JOB ADDRESS/LOCATION . ..� ,�0... . . .,.....�1`�-"tah .. C1rNSU5 TRACT Owner's Name /-,d ....... �`'��-.--....._.. Phone Address ... City ........ a. JG�.... _.. .._. -.._.... . MM Contractor's Name .. csr. c.� �........License #a�0i 7l7/.-..- Phone Installation will serve: Residence XApartment House❑ Commercial [-]Trailer Court :❑ Motel ❑Other .... .... .................... , Number of living units:.. .. ._.. Number of bpmdroos � Garbage Grinder---G'"' Lot Size/C2 -.. Water Supply: Public System and name f _ -G(1 - -----•------------------------..........-------.Private ❑ Character of soil to a depth of 3 feet: Sand ID Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ` Fill Material .... If yes,type ...... .... .. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK9 Size. . [- ...! l...... Liquid Depth ....................... Capacity/V_GG 44,1_'Type j � Material.�-�l� No. Compartments Distance to nearest: Well � - _ .......Foundation Prop. Line ........... 0 LEACHING LINE ] No. of Lines nZ L6ngth of each line _ �.... . .... Total Length 'P...``.......... 'D' Box Type Filter Material AS ......Depth Filter Material ............. ........... . ...._. Distance to nearest: Well , �......_... Property Line _� .ZG�-.�tl _ . Foundation /.a...._ . ............ SEEPAGE PIT [ Depth -------- Diameter .`. .__ Number .. ------------- stock Filled Yes A No o r ` Rock Size ... _ .._` Water Table Depth --.-.�.. --...------_--------- - •--- CZ --- ------------- Foundation .. _... .._.�.. f Distance to nearest: Wello-.-%_- - /O Prop. Line ..5................ REPAIR/ADDITION(Prev. Sanitation Permit# ........ ... ........ ........-_....------- Date --------......_-.---------------.) Septic Tank (Specify Requirements) . . . .... --- -- -- ------------------------ _------------------------------------------------------- - ....._-......-•----..... Disposal Field (Specify Requirements) .................. --- ----......... --.................----...... ... ... -•----• ------- -------_-_ ----------------------------•---------------------.._...- -- . ---- ....... . --- ----------------------- (Draw existing and required addition on reverse side) I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed . ............ Owner -- Title ... ....... � .----- By G�! -...... ....... ... _... . 11f other than owner) FOR EPARTMENT LSE NLY �� l APPLICATION ACCEPTED BY . DATE _/�..... _-. ..._.�?._ BUILDING PERMIT ISSUED DATE . ADDITIONAL COMMENTS ................. . ........ .................. - ---------------------------------• --------- ................-...... . ....... ... .. ............. ............................................ .......................I.............._...-----....---- ........... FinalInspection by; ------------------- ------------1._-..................... .......D e - _------------.-.... ... ............... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 13 241-'68 Rev. 5M 7172 3 M