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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: •� 1 Date Issued ----�'--z- - �� 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 install the work herein described. This application is made in compliance with County Ordinance No- 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION-----_ .__ -----g a _ __ +_------ POIC7,�_ _____CENSUS TRACT ______._____— ----------- -----------------=---------- > Owner's Name -------------------------- -------------- - Phone Address -�Q _ --,9_;r�------. City --------------- --- --------Q--- y Contractor's Name -------- -------------------------- License #/Z-i;,L/---- -_- Phone _ ------------ Installation will serve: ResidenceVApartment House ❑ Commercial '❑Trailer Court ,❑ Motel❑ Other ------------ ---------- --------------------- Number of living units: ..... (.... Number ,of,bedrooms __Y<..Garbage Grinder ............ Lot Size ..... f.�..�� 4-Wr.Q Y Water Supply: Public System and name ...................................... . ............._......Private Character of soil to a depth of 3 feet: Sand 'M Silt ❑ Clay ❑ [Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan 0 Adobe" Fill Material ----------- If yes, type ____________________________ (Plot pian, 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 ___,"f.__--------- :___. Capacity?-' ?�_ Type - .-..... Material.�d r�_._:E_ No. Compartments ...................... VV T t� -4 �.,.._ x Distance to nearest: Well __,___ .'f"` . ............Foundation-.:.. ._._ :.:..._ Pr"op. Line __ ....r._ .... _.; LEACHING LINE No. of Lines ------------------------ Length of each line------.. ----- Total Length ?a ................% ' D' 'Box'._...-..-... Type Filter -Material .,4&4_... -Depth Filter Material ....1 ............. Distance to nearest: Weft .___ _ ........... 'Foundation" �: r' '...... Property Line....__ .... r'�'........ SEEPAGE PIT ] Depth ____2_�________ Diameter. Number .___' # 5__ ____________ Rock Filled Yes j No'C] { iIt Water Table Depth, `;' -- ----------------•------->------ -- Rock -Size, '1-y----------------------- Distance to nearest: Well _____L_ -___ ________________Foundation Prop. Line ... 1 � REPAIR/ADDITION (Prev. Sanitation Permit #-.------ -___________________ 3_____________ Date _________________ --___._-__-____j I Septic Tank (Specify Requirements) _ Disposal Field (Specify- Requirements)-----------------...--....-`-.....------------------------------------------------ .............. ' (Draw existing and required addition on reverse side) I hereby certify,that,l;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: "II certify that in the performance 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---------- ------- I --- ----- -------------- ---------------------------------------------- Owner By --- ----- -- - --- -----"-------- ------ Title ---------- ----- ---------- [if other owner) -FOR DEPARTMENT USE70NLY '� /-7 / APPLICATION ACCEPTED BY .- ------ ti ; DA7E . .....................d BUILDING PERMIT ISSUED . v ti ------. -DAT ---- - --•-- - --------7777-- ,.� ADDITIONAL COMMENTS. a�f7/....L4 .��:�3'``a.i_. `1 v.��2-eit��.....-------- ..._�f�_�- F. ---------------------------- -�``a---r Final Inspection b-_---- - / _ A Y --------------- -Date *� ------ i G E. H. 9 �68 Rev. SM a , SAN JOAQUIN + � f LOCAL HEALTH DISTRICT