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FOR OFFICE USE: APPLICATION FOIL SANITATION PERMIT .... ........................ ........... Permit No. i (Complete n Triplicate) i. .. ..........................___1• _ ....._ This Permit Expires I Year From Date Issued Date Issued . ........ :..... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work. herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....... . - .....••..................................CENSUS TRACT ................ Owner's Name .. "�ti_.... 0.... ..............................r-------------.__.°................_.. hone_ . . `. P ° Address . -7 iff G ._..C . '------------•----------------•---•._. City G- A -�c*.,�r.... ,..... ... ... �^ p Contractor's Name -. . , l'' . ...G.a 1......... ----- .'---•-- ......................:........License # v s.�_ _ Phone �.7 n 4Z.� .. Installation will serve: ResidenceIN Apartment House•❑ Commercial []Trailer Court 0 w Motel ❑ Other ..... ... . . .. ....•--....I....------ Number of iiving.units:__.__`:-_:_ Number of "bedrooms. Grbage,Grinder .............Lot.Sixe �_.A._. G4...................... Water Supply: Public System and name -------- ...................................-...... ------.................................... ........ --.....Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ r Clay 40 Peat❑ Sandy loam ❑ k Clay Loom ❑ FT rdpan ❑ AdobeE] Fill Material ............ If yes, type ............................ s . (Plot plan, showing size of.lot, locatiori of.,system in relation to_N ells, 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 TANK I } i Size.......•....................•................... Liquid Depth ............................ Capacity .............•-..._... Type ----...7:-I--. Material...........6.......... No. Compartments ...............:.. J Distance to nearest: Well ....................................Foundation ....__ ............... Prop. Line ..................... _j ' LEACHING LINE [ } No. of Lines j-------.___.__ Length of each line........... .............. Total Length ------- Len ............................. 'D' Box ............. Type Filter,Material ....................Depth Filter Material .----:-----------....................•...... Distance to nearest:,Well ..................... Foundation _........--.__..._.._.__ Property line ................ SEEPAGE PIT [ Depth jq-T r___..,Diameter -6.U. Number ---------................... Rock-Filled Yes ( No. 0 ; ........-•----Rock Size _......_�. ! ° Water Table Depth "_-I�..�..� ............................. •-----... ... �. .. Distance to nearest: Well ._.`..tl-@___ Foundation .-f l�.a-�.-... Prop. Line ................... REPAIR/ADDITION(Prev. Sanitation Permit .--.---•.................................... Date ............................. Septic Tank (Specify Requirements) .............................•--.-........------------------- ..................... ..._._....................... ......._ ------------ Disposal Field (Specify Requirements) ....... ............T..._____.... ........--- ,-- C - ..........--- t ---------------------- --•--------•......................................•-•--•.--- (Draw existing and required addition on reverse side) I k 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 Lotal 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 becomp su 'ect to Workman's Compensatio laws of California." Signed --- w --{ - Owner . .................................. Title ................... .................. .....: (If other than owner) ' FO D PARTMENT USE ONLY APPLICATION ACCEPTED BY ....... -- •;r... . . ......---•------_. DATE ..-/:./� .� ........... BUILDINGPERMIT ISSUED --------- -----------------------------------------------------------------•--............_.._........._..DATE ......................................... ADDITIONALCOMMENTS ...........--...........................-....................................................................................................................... ........................................... ........ ............................... -----------------------......_._..--- ....... Da--- . i Final inspection by: .._..---- to ... ....... .............................. �� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1.3 241-'68 Rev. SM 7/72 3 m