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FOR OFFICE USE: APPLICATIONµFOR SANITATION PERMIT "- (Complete in Triplicate) Permit No. _- -_ --------------a ---------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 -------?��__�f ______ _ -___ -------------,��'T�l�l_�----------CENSUS TRACT --------------------._.._.. Owner's Name /YIf -/ � G'.1------------------ -------------------------------------------------------Phone __ +4 Address -)/43_�' - --- n-111 P - !!�'>' City h,f'- 111 g �----p--------------------------------------•---•---- Contractor's Name ----0- 1g License # y�3_(�Cd____ Phone -- - - �� - --�---�------------------ Installation will serve: Residence V Apartment House❑ Commercial �❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:---I------- Number of/bedrooms -_;2---Garbage Grinderr_____________ Lot tt-Size f`J _ �_!� ___________________ Water Supply: Public System and name ----fl-1 .��7-mss ------e4l7- - 1/��1--_�!/eze"Z-------------------Pave+e-� Character of soil to a depth of 3 feet: Sand'�K Silt❑ Clay ❑ Peat❑ Sandy Loam '❑ Clay Loam ❑ 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 TANK'[ ] ize__________ ___ Liquid Depth ____________________,___. ------------------ ------------- - Capacity -------------------- Type --------- ---------- Material-------- ------------ No. Compartments ---------------_. W Distance to nearest: Well _______ ____________________________Fo dation ---------------------- Prop. Line ________________-_-___ LEACHING LINE ( ] No. of Lines ------------------------ ngth of each line_ _____:_________..____ Total Length 'D' Box ------------ Type Filter aterial __________________ epth Filter Material ______________________________________...... Distance to nearest: Well - Foun ation Property Line ........................ 11 SEEPAGE PIT [ ] Depth -____ Di eter ________________ N be -- ------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth --- -- ------------------- -----------Rock Size ----------------- Distance to nearest: ell ________________________ --------------Foundation -------------------- Prop. Line _._.____--________. __ REPAIR/ADDITION(Prey. Sanitation Permit ____________________________ _______________ Date _____-_____---__._______-__._____-) Septic Tank (Specify Requirements) ----- -------------------------------------------------------------------------------- --------- ----- Disposal Field (Specify Requirements) -/ -..1_P-44__ _/_____ `____________ _ ___ __��._��____ 5�--- -------------------------------------------------------------------------------------------- ------------------------- ----------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------- (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 orkm 's Compensation laws of California." O Signed --------- W,7 Owner BY ----- - --- --- -- ----- - --------- Title -------------------- ---------- ----- - - ---------------------- ---------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- f ------------------------ ----------------------------------. DATE --- 3 7`3 BUILDING PERMIT ISSUED -------DATE --------- - ------------------------------ ADDITIONAL COMMENTS ----------------------------------------------------------------- - --------------------------------------------- - -- - - - - - - - - - Final Inspection by- -------------------- �l - -------- -------------=----------- - ---- ---- - ----------Date ------ —23------L),_ -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M G� \I—_ _..-