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FOR OFFICE USE: 1,1W r•1111111, APPLICATION FOR SANITATION PERMIT ....................................... ...... ... ... ................................................ (Complete in Triplicate) Permit No. ./.. c..7..1� .. This Permit Expires 1 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 app?kation is ma*.y, cQppp��pli p6e ith County Ordin nc o. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ,r/ GCL�._ '- .CENSUS TRACT S /t........ J mac'r�t .�rC.��-.. .. n....._ - Owner's Name ... ..._... ............................................ Phone .................................... / ' G� r;t YAddress ..............,� •-•-.........-..........- ..................................................... Contractor's Name ---.........License # .... Phone .............................. Installation will serve: Residence(Apartment House❑ Commercial ❑Trailer Court 0 Motel [-J Other............................................ b. Number of living units:._.....-. Number of bedrooms ....s;'�...Gcrbage Grinder ...--------- Lot Size ............................................ Water Supply: Public System and name ...............................................................................................................Private a Character of soil to a depth of 3 feet: Sand❑ Silt D Clay ❑ Peat❑ Sandy Loom B' Clay Loam ❑ Hardpan❑ .%dobe ❑ 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[ ] Size........................... .............-..... Liquid Depth .......................... Capacity ... -. .... ..... Type ...._.............. Material. ..... .............. No. Compartments ...................... Distance to nearest: Well .... ...............................Foundation ........... .......... Prop. Line...................... LEACHING LINE ( J No, of Lines Length of each line ....... . .. ....... ...... Total Length ............................ 'D' Bo- . ... . Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest: Weil ...- Foundation .. ..................... Property Line ........................ SEEPAGE PIT ( J Depth - ...._._. ..... Ciameter .............. Numbe• ..... _ ................ Rock Filled Yes ❑ No Q Water Table Depth .......... . .................................Rock Size ................................ Distance to nearest. Well .. ....................................Foundation ..............._.... Prop. Line ...................... REPAIR,'ADDITION(Prev. Sanitation Permit# ........ ... .... ........ Date ..................................I SepticTank (Specify Requirements) . . . .... _................................. ...... ..•-----.... .......-•---................._......—...`_.........._...... Disposcl Field (Specify Requirements) LZ. ..............— -'-.. 17 ... - :,�1�� `?�. '` ._......-' Vl _.. ............... .... - ........................ .. ... .. ....•----------------------- ...... .. .................... ... . ---...._.......... .----------- (Drow 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 performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed 1rJ n Owner yc�......_ Title7� tQ AJv. (If other than owner) FOR DEPARTMENT USE ONLY APPLICAT!ON ACCEPTED 3Y ;,;P- yf- . . _ DATE ..... BUILDING PERMIT ISSUED _ __. __ _ . ...... .CATE . . ... ......... ...-................ ADDITIONALCOMMENTS _ _ ...... ........ _ .. ... .... _ .. . . _ . .......... .............l+.. ... Final Inspection by: Cate A-1 / .70.... SAN JOAO!J!N LOCAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M