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)FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..............��...._..........................•......... (Complete in Triplicate) Permit No. .��~...`�~.. - ..........•••-- ry Date Issued r; 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 madein rgplionc4 with County Ordinance No. 544 and existing Rules and Regulations: I� S T ........:...............o JOB ADDRESS/LOCATION .... rte' '�f _.._._. �. L -.-- ...._:-:....,.Tr... .......:. ........CENSU EI �. .. / Q. G.I, 42 ... .. • _ ---........._ .....................Phone R Owner's Name ......... -••---� �� Address ...... U.._. :- lJ, ilrl� City L4< 1 ...... ..................... ...... Contractor`s Name �� i�:� /��L� /� `� Phone `f, 5 ..•...... -•.__.....License # - Installation will serve: ResidenceR Apartment House❑ Commercial:oTrailer Court ,❑.. Motel ❑Other ---------------- ---------- ---•-•....... 1 Number of living units:..-. ---- Number of bedrooms ..- ...Garbage Grinder .ft---d.._ Lot Size .. ..__... Water Supply: Public System and name .._......... .__-.............................•.•... = Private [3 Choirocter of soil to a depth of 3 feet: Sand❑ .Silt❑ -Clay ❑ Peat 0 Sandy Loam ❑ � Clay Loam ❑ ; ❑ _ if yes,type ..... ........... __.__.. Hardpan Adobe Flli Material _.... = (Plot planowing.size of ITt, location of system in relation to wells, I uildings, etc. must be placed on•,reverse side.) 1 NEW INSTALLATION: (No siptic tank or seepage pit permitted if public sewer is available within 200 feet,) t ... Liquid Depth ............. PACKAGE TREATMENT ( ] SEPTIC TANK'J ] Size--...............:. . -.....-.----• q p .......---... sMaterial_._.....__.-•---_-.... No. Compartments ................. !, Capacity --- ................ Type .................... jDistance to nearest.• Well ..Foundation ...................... Pop. Line ----...........--- ' ` LEACHING LINE [ ] , No. of Lines . Length of each line............ ------. ... Total Length ......... E 1 D' Box Type Filter Material .....Depth "Fi ter Material ' Distance to'-iearest: Well ............�-•--- ` Foundation ....._F..----•-_.......... Property Line ........ ............... . mV : .. Diame ....... Rock Filled Yes No [ SEEPAGE PIT [ Depth+ .......... p Water -Table Depth. ._ `.. Rock Size __...... ...... Distance to nearest: Well __Foundation -------------------- Prop. Line ...................... •-----------•---••••••............... Ej REPAIR/ADDITION(Prev. Sanitation Permit# -•__-•-...-•---•............. 'Date _.:..:.........._..-I............. Septic Tank (Specify Requirements) ............ . . , . Disposal Field (Specify Requirements) .-...........�......................................•-•••--._........---------- ----------------•--- ------------------------------ -------------------•-•................................................................................................... ............................................ ................... I ................. ............................-.......................•......•....................... �l (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application aro that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regular) s of the.San Joaquin Local Health District. Home owner or licas*- sed agents signature certifies the following: ;zs, I`certify that in the performance of the work for which,'this permit'is issued, I shall not employ any person in such manner alio become subject to Workman's Compensation laws of Callfornia." ' E5 Signed .............. Owner ------------------------•-----------._.....- tle - i................ .s (if other than r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .............. ..... DAVE 3- -L-� 7-:J...-.-----.... I BUILDING PERMIT ISSUED . ............. .. .. • • ... .. ATE ....---- ............ ...........• ---.... ri . . . ..... :.. ADDITIONAL COMMENTS . �`'..�!►.�. ?. ... .�z •-- ... .... ...... .. ... T " ......................I....................... �1.._ ....- ( --•................................ ---•- .............................. .. __....:...... .Date .. ...:. :..... �..... ... Final Inspection b p Y' ---.: . •- Li'l.•- - �-••- - - ......,--- SAN JOAQUIN LOCAL HEALTH- D15ICT rR 7.-/72 3 M ;