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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..y ...................................... {Complete in Triplicate) ................................. ............. Date Issued This Permit Expires i Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and ----------- 5r. Regulations- TRACT ns�: TRACT ...............:..... ..-. •-- JOB ADDRESS/LOCATO ._.....Phone Owner's Name ... ............. ----- - --• ---- , K7e......................... Cit Address Contractor's Name W � :-_- -L-icense #o2... _.t6 5.•=2ZPhone I Installation will serve: Residence Apartment House C) Commercial.❑Trailer Cou;-t I]' Motel 0 Other � _.� .., _a �.,..._ r — Num.�, �..-e rber of living;units:.. ...--.,,-.... Number of bedrooms _ -.__._..__Garbage Grinder ... .,.--�--- Lot Size..-__ .- ............... . .•- _••• - Private F-1Water Supply: Public System and name ........................------------ Character of soil to a depth of 3 feet: Sand n Silt❑ Clay El Peat❑ Sandy Loam Clay Loom ❑ d 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 ewer is available within 200 feet,) I PACKAGE TREATMENT [ J SEPTIC TANK[ J Size.... --- --------•'- Liquid Depth ... -._ .__.. Capacity .. Type -------------------- Material...... ..... No. Compartments -......... ......... � i Distance to nearest: Well . ,�j.4........................Foundation _..-_.G-...---._--.. Prop. Line_..._......-� } LEACHING LINE j I No. of Lines v�._ Length of each line.....---`►] � �...._- total Length ... 4--0 /I 'D' Box -../-.- . - Type Filter Mated /y �''1Depth Filter Material _-_. -.�� ..__..._-- ,m Distance to nearest: Well 6;a---------------- Foundation �� Property Line -.-4 ..._--._••- SEEPAGE PIT [ ] ; Depth ._ .. Diameter _.. Number ........ ............:...... Rock Filied Yes ❑ No WaterTable Depth ----------------- -------------------------....-Rock Size -------------•-•-•--- -- ---- - i Distance to nearest: Well -•---•_-_-•---------------............Foundation --_................. Prop. Line ...................... 1 REPAIR/ADDITION(Prev. Sanitation Permit# .''..:- ------------I—...... Date --------- •...... ) i Septic Tank (Specify Requirements)•_ y'_,---`•- .---... ......... -------------------------------------.................................. .... Disposal Field (Specify Requirem ---_------------------- ents) .. --------------------------•--.......... --- •---.... $ ------------ .............. ............ .. -- ..-_ ----- - -_..___•----....- i } i 1 � .. F..a�r�.-._. .. %tib-:m^r`snrc� _....-....................................• ...F.. ....................................................---.... A (D aw existing and_regt red addition on reverse.side) I hereby certify that I have prepared this application and that the work will berfone in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local*Hedith District. home owner or licen- sed agents signature certifies•the following: T _. "I certify that in tiie performance of the work for which this peri It is issued, 1'shall not ernploy,any parson in such ma er j as to become subjg to orkma 's`Comliensation la-ws'of Calif6rnia." i 4 Signed .... Owner I. 9 ' ---------• Title . -. ........... . ...'_..}..:.. ..:.._...-..........-. ------ By .,,. (If other thari•owner) j FOR DEPARTMENT TMENT USE ONLY—' � - APPLICATION ACCEPTED BY ............. DATE ...-...�-. '.. .6 . •••••---- BUILDING PERMIT ISSUED ...... ........ .- ".�' - .._......._DATE ADDITIONAL COMMENTS ------ ------- -- .............. ------------...----....---- -------......................... -. -._.._....'_T _-. _ .x:.•.cC: '� .. . - _.•---_. _-___._.._...__ •_.._-._-_______-•._--...._............ ....._`..... ............ 5 ...................... Final Inspection by: - .. SAN JOAQUIN LOCAL,.HEALTH DISTRICT 13 24 1_-s.n v... r� - 7/72 3 ,K