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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: •..... This Permit Expires T Year From Date issued Date Issued _7eg.<-1:744 i 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 mode in compliance w' h County Ordinance No. 549 and existing Rules and Regulations: ' JOB ADDRESS/LOCATI .� -,0...... _. _ l Q _,! ...... c�C .....CENSUS TRACT _ Owner's Name ... G [,c �.� f ..Ph I.....T._......_ Address - •••;-�•;r• ..Phone.`�` GZ ............................. .....:. Contractor's Name .....- ;-•-.-• // .__A. ------- •.._...•..........:...... z2.7_19,17/ Phone .•4`6 .License # Installation will serve: Residence App tment House 0 Commercial❑Trailer Court 0 E E Motel j]Other . ........................... Number of living units:... Numberrt' of bedrooms-- ------Garbage Grinder .__- ------- Lot Size .� Water Supply: Public System and no e ...................... Character of soil to a depth of 3 feet: Sand jr] Silt D Clay 0 Pept❑ Sondy Loam j] Cloy Loam 0 Hardpan D. Adobe [, Fill Material --------_-- If yes,type -------_------------•- (Plot plan, showing size of lot, location afssystern 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,] I' PACKAGE TREATMENT [ ] SEPTIC TANK .............. Liquid Depth __.....i f � Sia®._....._.... Capacity --- ---------------- Type •------------------- Material_...._----..:__,...._. No. Compartments ._.__._...... 1 Distance to'nearest: Well t ......ly Foundation Total L'Prop. Line ..................... LEACHING LINE j ] No. of Line, ........... Length of each (ine.t..--- ------ -- --• er th ` - IN , 'D' Box Type Filter Material) Ilz—_ - Depth Filter Material _ ..:... . Distance to nearest: Well ........................ Foundation p rtY Line �' SEEPAGE PIT [ ] Depth . Number .. Rock F P ----•----- Diameter - filled Yes d No (;L; , Water Table _Depth --- .................... Rock Sire ... rJ '.9 2:i1y. - �.r.:ra--�...,w�- •+ ........................ Distance to Barest: Well Foundation 4 � to Pip Line _ REPAIR/ADDITIONi S Prev: antation Permit /` G { --•---------------••--•----------....------- Date ._.:___::.: .._;�-,�---= ...... 1 Septic Tank (Specify Requirements) t3 < _. .... Disposal Field (Specify Requirements) • ------------ ?� ---------. --------------------------------------- ........................... . .._. y .:� �_d•-.> t raw existing and required add ition'�on,r ......_ _t................ ........... -reverse side}','� - .....I....... I hereby certify that I have prepared this application and that the work will lie done in accordonce with an Joaquin CouYV nty Ordinances. State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: V "I certify that in the performance of the work for which this permit is issued, I shall not em lo- a h` P Y y,parson in�i vch manner as to become subject to Workman's Compensation'laws of Callfir_mE," Signed ....... .. .. .... Owner --------------------- By $y f ' * . . ... .... .. .. �- .''� - -- ..... -.--- �•�-�-�--��...._.. Title ._�_ ._:: , . ..- (if ather than own - ....._...... ...... -•-------•••- _ DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY ... ___ DATE ._.._�'r ,� ••... .. BUILDING PERMIT -ISSUED _:.-•----------•-•-_--- • .......... ...•- -•--...:..._. _ ADDITIONAL COMMENTS DATE ... ................. ..................... .. •---- .•••.......... ........................••-•--.... ....._...... .......�....::: __:.. ......... . �. Final Inspection by: ............... :�;tr..._..... _......-..........Data SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. SM