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-a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _. .............................. , {Coi#iplct�n Triplicate} Permit No. 75.'. 3... - - g Date Issued ��-; 5..75 ....................•_.... "'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 trade in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ............1 --8/-��..� W' � . �'a ...._...�-r.-c._ ...CENSUS 'TRACT Owner's Name ..._..._..•1"_``.��! ..:...._ �_`'' e. ��.. �.. .......:..�.::. Phone .................................... Address -- ............. � r`rI City - 3 • .. _ License ` .... PhoneContractor's Name �• . Installation will serve: Residence a Apo rim ent-House-❑ Com mercial-❑Trailer Court 0 Motel C]'Other�..:..............: Number of living units----- Number of bedrooms .......Garbage Grinder ----- Lot Size ... ................ Water Supply: Public System and name .... .........:......... .•:_-,-•,-......---•:.-;_-----.__ _:..._:.-......-_.---._...:__---__.._____._.__.._..Private Character of soil to a depth of 3 feet: Sand ( Silt 0 Clay ❑' Peat❑ Sandy Loom 0 Clay Loam ❑ Hardpan ❑ 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.[ 1" r 400 NEW INSTALLATION: (No septic tank or seepage pit permitted if.public sewer is available,within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size------------- .......--------•.---.............. Liquid Depth .... ...................... W l Capacity .......:......... Type Material No. Compartments Distance to nearest: Well ....................................Foundation ...................... Prop. Line ............ •• LEACHING LINE [ ] No. of Lines ........................ Length of each' line--_-_...____-•_.-._..._..._. Total Length .......... .............. to ". 'D' Box ._------- -- Type 'Filter-Materiol' -....:::.::!:..::__Depth Filter Material --- ................. Distance to nearest: Well Foundation _.. ................... Property Line ..................... SEEPAGE PIT [ j Depth ....................... Diameter _.......:....... plumber .........................^,,,Rock Filled - Yes ❑ No ❑?l'1 F Water Table Depth ' ........................Rock Size A0 Distance to nearest: Well .........................................Foundation -------- ........... Prop. Line --------- ............ d REPAIR/ADDITION(Prev. Sanitation Permit# --------------------•.......... ............ Date ___.----------------------------_-j SepticTank (Specify Requirements) ...................•. ------. --•------ ...................... .................--............-.........- ------ -------------•--- Disposal Field (Specify Requirements) .....__.__.��d �` f.......... ....�d�f-T.��' ..Pic, A.....: _��!.e ....__.._.... , , �i� ..............:.�j.Tf--------------------C A4 ----------- ................... .................. -------------------------------------.__.........------------------------- .-----•--------------•-•-........._. -------- ••------- \ (Draw existing and,required additiomon reverse side) \i 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:; E "I 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 Compenscition'lows of Callfornio."" Signed ...... venom f Sa hr '._ .. . '...-•-•--- ------------------ •. ---•---------• .:_ :_ Owner' , J BY �---------- : ................ . . ::x:: Sitle .. (if o wnerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ........ :..... .... . DATE ........ •• ........ � -..- BUILDING PERMIT ISSUED --------............:.. DATE ............................................. ADDITIONALCOMMENTS -------------------------------------------------------------=----- -----------------................................................-••-•----.........-•--•-•- ---•...............•...._....-•-•--. ......... . .Final Inspection by ............................. .........................Date ..../............ ........................... SAN JOAQUIN LOCAL= HEALTH ,DISTRICT 11N- E. H.13 24 1-'68 Rev. 5M .-m ... - 7172 3_M