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FOR OFFICE USE: -� '..............................:... �• APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ...1.r".aZ-�._1.. -............................ ............... This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the Spn Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Coun4ty�Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION ,.. , G[�c.c. .....� . --- �... ..._ .................CENSUS TRACT ................... Owner's Name ........ .. . _p.............................................. *.... ....... one .� Address ---3.Q-4-.o..9. .~.-- .. -Com!'..... City .. .................................. ....... . . Contractor's Name .. a.- r.....0-.1.115.1.0-A/.......................... ------.License #_ - -. Phone ........... . . Installation will serve: Residence jZ Apartment House 0 Commercial [jTroller Court ] 'Motel []Other ........... •-- Number of living units:............ Number of bedrooms .........Garbage Grinder ..------- Lot Size ..._.-_,.--.......__._ ................ Water Supply: Public System and name .......................... -_.--._-. ................................ Character of soil to a depth of 3 feet: Sand 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 T j -Size...-_-:__._____-'-F•---.....................--..: liquid Depth ..........................Q Capacity Type Material:!"^ No. Compartments ..................... Distance to nearest: Well ------..............................Foundation .... ................. Prop. Line .................... i. LEACHING LINE [ ] No. of Lines '............------------ Length of each line.--.... .................... Total length ........................ 'D' Box .. ......... Type Filter Material _.....Depth F+Iter Material . A Distance to nearest. Well ........................ Foundation :....: ..__.._.-.:- `Property kine ........:..--•-=:= :, i SEEPAGE PIT [ ] Depth ----•.....:......... Diameter ---.-.......... Number .......... ............. Rock-Filled' ock-Filled Yes ❑ No.0 Water Table be th ..Rock Size ' i I • Distance to nearest: Well ...Foundation .. Prop. line ' �,.. REPAIR/ADDITION(Prev. Sanitation Permit'# Date Septic Tank (Specify Requirements) ----- ...... - ... 7..........•...... Disposal Field (specify Requirements) .----...- i?�. "�+_' --..1.-....-_ . __d=t .-- - --- �........... .. ............ --•----•--•------------------•••-••-----.......---•--•-•----••-----•----- - .., ......._... ...-•----------------- --- ... •----••---•---•-•---... ..--•--•------. . .•.... --... .-- ....... - . (Draw existing and required addition on reverse side)— I hereby certify that 1 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 sliali-not employ any person in such manner as 10 become subject to Workman's Compensation laws of California." Signed ----J9 ------t?""a"'"''.............................. Owner By ..... ,..IF ... ................ y-:�... .. Title ...... nrs. .........-................ :.-.......-.--..... K. (If other than owner) F9ft DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............. . ....::. `=...,.......... .....��. ...:....-•....................- . DATE...........y �. -------- BUILDING- PERMIT PERMIT ISSUED ...... = :......................................................................:..............DATE ........................................... . ADDITIONAL COMMENTS ...----• �......,; A ................• - .... t -------------— -•••---- ....................... ------•------- --------• �. .. ...............----------------• --- ..........••-----...... n 5 Final Inspection b e -"..•. p y; .............----- ..... .•---- .. �=-••-----=•............ .......... ........................Date ..•.-.. :.-1.�..T��S�-..--•. - SAN JOAQUIN LOCAL` HEALTH DISTRICT E.-H. 7.3,24 1-'68 Rev. 5M 7/71 1 u