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F FOR OFFICE USE: 3a APPLICATION FOR SANITATION PERMIT .......... .............. ... . Permit No. ..._._....._..... ... (Complete In Triplicate) ..... •. ................................. Date Issued ..4�71...7."3. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct.and:�i.instali -the work herein described. This application is made in compliance with County-Ordinance No. 549 and existing Rules and Re-4ulations: _ / c J08 ADDRESS/LOCATION .... ...g.`/........_: ... ..... .....1...1_.1 .......................CENSUS TRA - / r 3-.0 Owner's Name d.........��i.................... .... '... ,fes .c% -Q- -----. ----^ Phone . _ ... o e Address .."7W/ : ....� ... .... :`.................. City _k r � /.Q .:..................................._ Contractor's Name .--- /'? �... -•-------1� ------ ---------------•....License # 1 .3..x. Phone�� .'. �..... Installation will serve: Residence partment Houseo Commercial❑Trailer Court ❑ Motel ❑Other _- "� ---... --- - - - ----- Number of living units:._._.....C, Number of ro Garbage �Grinder Np.... Lot Size �Q-�., -• p-=--•• Water Supply: Public System and name_. -------• '- `'�—....................................................Private ❑ Character of soil to a depth of 3 feet:i Sand❑ ilt❑ Clay eat❑ Sandy Loam ❑ Clay Loam p Hardpan ❑ Adobe Y e ..... 1{I Material a-. if es,type Plot Ian showing size of lot, location of:s. stem_in_relation_to..wells, buildings, etc. must be placed on reverse side.) 0 ( P 9 � Y s NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4 PACKAGE TREATMENT [ ] SEPTIC TANK t!;) Size......................................... . Liquid Depth .......................... Capacity T Material.. _------- No. Compartments t t Distance_to nearest: Well ....................................Foundation..................... Prop. Line ...................... LEACHING LINE [ ] No. of-Cines ... ....:............. Length of eachl line......`...................... Total length ..................... i ' 'D' Box Type Filter Materia( ....................Depth Filter Materia! ........................................... r -——Distance tomearest: Well ........................ Foundation `_..._ --------- Property Line .......................- } ._. Rock Filled Yes No � SEEPAGE PIT [ ] Depth _--__:;�.�-�_:._.__: Diameter .........:...... Number ...__..._.___.._�......._ ❑ [) ,L -Water Table Depth ................................................Rock Size .................................. ---s f L `Distance to nearest: Well ........................................Foundation ..................... Prop. Line ...................._ REPAIR/ADDITION(Prev:1Sanitation Permijt# _........................................... Date ......................._....... ..) Septic Tank (Specify Requirements) ....... .... ._.._--_-- ---- o ....._ - 1- ----•---- Disposal Field ,(. ecify 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 Lthe 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 BY G�." ..... . Title ....... .. (If of r than owner) FOR D PARTMENT USE ONLY k APPLICATION ACCEPTED BY ....... /,:.IV......... ........ ... .... .................................................... DATE .._� ..1. ....�...�_.._.... BUILDING PERMIT ISSUED ...._.... DATE -.....____• ADDITIONAL COMMENTS ....... � ...... .. .rp._. ..> .�. 7 ........ - ...................................••--.... ......•----•--......-•-- .......-----------�.._.•-----...--•--•-•--................_........-- ...._ ............................................ ..._ ........... .. - --•-•-----••••...----------•----•-------•- ---.-------- ------- . ............ ----------------------- ..................... .. ... ........... .............................._...........--•-•-----........ _. .. - Date ... . . Final Inspection by: .. .............. _,-,-SAN JOAQUIN.LOCAL HEALTH DISTRICT _ 13 241_ /,A Rpv. 5M - ' 7/72 3-L