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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................._..................... (Complete In Triplicate) Permit No: ..............................................---------. This Permit Expires I Year.Frem Date Issued Date Issued Application is bNeby made to the Son.J .aqujn..LQtal o_aIthDistiict-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: - 7 JOB ADDRESSAOCATION _-`S...r----d_411.�ti- --------e ' _.-`-•f-.....-�..... . ..-.-p- /�sQ--CENSUS TRACT .....s.`?l.1............. Owner's Name ----n--- ... -- ------Phone......--............................ Address ...............aF.... P.t?4K_...-1. w_........city -..1w`. _r .-_n------•------..._...._...............-. Contractor's Name r_ .. .�.. .-._s!'..•.-- +.--.-------._:.....-..License tP _��. .rF.Y Phone ............................. Installation will serve: 'Residence❑Apartment-H-ouusseeo Commercial Trailer Court 0 Motel ❑Other ------1/L --- Number of living units:..._ ----- Number. of bedrooms . -..Ganga Grinder ....._...... Lot Size .... ------ Water Supply: Public System and name ................................._................... - ......._..........................................Private Character of soil to a'depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 1] Clay Loam 0 Hardpan pt Adobe ❑ Fill Material ............ If yes,type .... ....................... W (Plot plan,.showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} c0 NEW INSTALLATION: .(No septic.tahk or seepage pit permitted if ublic,y sewer is available within 200 feet,) _\ PACKAGE TREATMENT [ ] SEPTIC TANK (� Size .,rel...f..1.--i._... f.......... Liquid Depth ... _...-- } Capacity�.:w�t.o. Typed -..jam.--` Material--- .-. Na. Compartments ..rte.. ......--•-- r Distance to nearest: Well ------ �-�.................Foundation. _4-.,..-..... Prop. Lina..S...•!'-,-•--- ' LEACHING LINE [ij�No. of Lines ........7..-..._-..'. Length of each line.........(................ Total Length ............ .. y 'D' Box .r.—..... Type Filter Material .-�..r........Depth Filter Material ---,1..?....................._........... r S^ i Distance to nearest: Well -... e.............. Foundation ........1.8._..._..... Prop" Lints_ -..-..--.-...-.......... SEEPAGE PIT [� Depth ....2. ...... Diameter .;- 3-�... Number .........a............. Rock Filled Yes IM No p k, 't h Water Table Depth ------------g [-...................•-•--.Rock Size .1 --- -- •---- [ Foundation ..1.6-1------- Pro »./ Distance to! Wolf ........L S?4. ............... p. Line ...... _......... REPAIR/ADDITION(Prev. Sanitation!Permit sR...._..._.--........ ............... Date .................................I SepticTank (Specify Requirements) ...................................... --------..............------........._....,.........p........_.--.. ........-............. Disposal Feld (Specify Requirements) ....._.... _.....•............. --•...............................................--•----------- .................... -----------...............----..._------..__........-----..._...........7........_.............------ ............... ..............................W."------ - --- ------------------------------------------ ----....... ------------------------ - -------- -�-------- - ............................ -- -- ------- ...._....._...----- ---. { (Draw existing and required addition on reverse side) 1 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 pe,rFormancer 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 .............................................f...... _..... ..........-..._.................. Owner r-- By -----'---.. . -----......................... "-............... Title (if other than owner)I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --.-----.----------.--.-------------------------------- DATE -.�:.7:n_.7.2----------- ------ BUILDING PERMIT ISSUED........_..• _ _ DATE ............................... ........... ADDITIONAL COMMENTS._. - - 46_ �-._--..._.... ..._....------------......-._ - ---------------------- --------------- ------ ------- ------------------._....------- -..---------.........................................._......_'_. ....... ._.........-- e"c"tI - z_.. -...... -.. . '- - - - - x'7`7: Final Inspection by: ---Qf5r�.A.e- -------•--. .._---------------------------- ---------Dote•-- .l.r�............-..-..----------- I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM 3