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;FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ._.... -nl.l_y ............................................._ lThis Permit Ex ices 1 Year from Date Issued Date Issued Application is hereby made tc the Sd 7foaquin oca ealth District 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: t. ( �/ ser JOB ADDRESS/LOC C7N .. a......•. .. ems. .5f��_ ...._... `(.'2 .L.�1........................CENSUS TRACT � ary Owner's Name E?.xt�_s..._•. ,... -------------------------------- ..Phone .-.-..�?.��....-- Address " �?. ��} ...._..:.. - �C°.i.( --�3 - City .--"� 6 -......--•..................... Contractor's Name--, / Qf Tax -•� rr -•- --�..:-�:��i..x:_ -,5...--------�°-��/.��-•-�G�,�-_�t___.License # -------X113..1.. Phone ...... . ...... . ... . Installation will serve: Residence V Apartment House f] Commercial-OTrailer Court 0 Motel ❑Other--•-•-••--- ................................ Number of living units:__._._.__ Numl ber of bedrooms ... .•.Garbage Grinder .. Lot Size .__.. �_1.... ...................... Water Supply: Public~System and name .-•------•--...-•---.....-•-------..........-----------_-..................................................Private Character of soil to a depth of 3 feet Sand 1] Silt C1�'Clay 0 Peat E wSandy Loam C] Clay Loam.0 Hardpan i Adobe p Fill Material ............ If yes,type............................ ` (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if,public sewer is available within 200 feet) a PACKAGE TREATMENT { J SEPTIC TANK - Size.. t .. ...YZ __..___ liquid Depth ... r Capacity ------- Type . a--------- Material.,&&eY_e.1_�S No. Compartments .I.. Distance to nearest: Well ___._ Q......................Foundation .............Prop. Line'.--..-Y LEACHING LINE No. of Lines ------- --_•--.___. Length of each line------- ...... Total Length "�--.dQ.--------.- 'D' Box ...... Type Filter Material .....A-----------Depth Filter Material........ _..7._,............................ Distance t Well .. S4 .......... Foundation —149-1 Property Line ...................•.... SEEPAGE PIT Q(J Depth __._. __.._ Diameter ..✓�5_"' Number ......... ............. Rock Filled Yes '® No 0 Water Table Depth .............. ---------------------Rock Size -----.12: a Distance to.nearest: Well Z4a.'_...................Foundation ...1 .t9 Prop. Line ...fd..-------- REPAIR/ADDITION(Prev. San itatiorilPermit# _---•-_•._----•......... .................. Date .................................. } Septic Tank (Specify Requirements) ......................057- 1......_!�I'c� ---...-------- ................._._,..........--............... DisposalField (Specify Requirements) ..................... ................................•----•---••- ---.....--•--------•--------•-----------•---.....-•••••.......... --...._._......................•............... ......-L............................... ................................_...... ................. .............. -------`-••••--•---•--...... •---.--. a �. _ ........�..._�-..� ... 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, aed'Rules and Regulations of the San Joaquin Local Health District. Home owner orlicen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .........................•-•--•--....-•---•---- -•--•--••---......-- ... Owner ` By ..... '`o `..... ............ Title ....... -•--•----•--••- (if other than owner)/ FGR .DEP TAtINT USE ONLY APPLICATION ACCEPTED B _ DATE .._... ..! .7f........... -------------•....._.........._ BUILDING PERMIT ISSUED ......----- ............. -------- •--•----•- ••..............:•----••---...DATE ........................................... I ADDITIONAL COMMENTS ............. = _.. - ....... ................... - r i .............•... -............... - .......... -,....._ --------- ----- ---- --- - r : : -----•-- ----- - final Inspection by: aiI•- ------..........bate SAN JOAQUIN LOCAL HEALT+i DISTRICT E. H. 9 1-'68 Rev. 5M