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7. -_ FOR OFFICE USE APPLICATION FOR SANITATION PERMIT ..................................•-..................... Permit No. (Complete In Triplicate) Date issued This Permit Expires 1 Year From bate 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 pllonce h County Ordinance No. 549 and existing Rules and Regulatlonse II. JOB ADDRESS/I. r ?. Q l.. n .�. ..��!`�._R�. _191! .:......!! ' .............CENSUS TRACT ... ... ff.. Owner's Name � - .................. 5' C-.. . .....................:.....................................Phone .. QC1... x�ddress 7 ....City .. ........................................... .. . .................. .. ... .. . . Contractor's Na f=-- r ' __._" '- �': ----License # ........................ Phone Installation will serves ItesidenceoApartment House❑ Commercial OTraller Court 0 Motel ❑Other Number of living units:-----f.... Number of bedrooms-_-.'_.F:.....Garbage Grinder ............ lot Size .----1.111LIZ-S. .................. Water Supply. Public System and name .................................r_..--....._..-----------......._......__..................................Nlvate�' Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat Q Sandy loam❑ Clay Loam ❑ Hardpan❑ A-dobe —FIII'Material ............ If yes,type ............... ............ (Plot plan, showing size of- lot, location of system,in relation to wells, buildings etc.. must be placed on reverse side. , k NEW INSTALLATION: (No septic tank or seepage pit permitted of public sewer Is available within 200 feet,) I PACKAGE TREATMENT [ ] SEPTIC TANK] ] Size----------.......::.............................. Liquid Depth ._...................... Capacity Type Materfel................. Na Compartments Distance to nearest: Well. ........................"Z--------Poundation' ...................... Prop. Line ...................... ' LEACHING LINE [ ] No. of Lines ........................ Length of;e ch line..:...................... Total Length 'D' Box ............ Type Filter Material f:::.=................Depth Filter Material ......::......::............................ Distance to nearest: Well .............. `......... Foundation ........................ Property Line ........................ SEEPAGE PIT [ D Depth ..................... Diameter,. Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth ........................... ..Rock Size W Distance to nearest: Will .........................+.._.,_.._._..Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prov. Sanitation Permit# .......:...................................... Date ..................................1 peptic Tank (Specify Re ante) ...... ......... . ................ ..................._................. r l7;sposal Field (Specify ltequirementsy . . .. .... ......... ... .........:. ............. . .---.-•-------- ----•-------------- f ..._.........._ - __.... -... .... ......... ..... (Draw existing pnd required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r County Ordinances, State taws, and Rules and Regulatlons'of the Son Joaquin Aacal.Health District. Homeowner or Iicem sed agents signature certifies the following: ; "°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 bec subject t km 's-Compensa ws a tallforniey", -.gnec F_ :i.. .ryL� 1rq H... f �� -F F?= 4..i. .. Owner ' k By ......................................... :::---. ..: :. .. - ..:.:7erl e --. �?� .... ... ................ (if other,than ownerl f R DEPA E E ONLY APPLICATION ACCEPTED BY ...:.._. �...................... DATE /. :--. ...�........... . . BUILDING PERMIT ISSUED' " .W� :..:. ................:.;1........:...:._....................._._... DATE ........ ADDITIONAL COMMENTS ...... ........... ............................ .. . ........................................... ... •-----......--- ................ � __ .................. . . .....-----........... . '.............._............ . ....... ................ ... .......... . .... ...•-- ... . -- . .................................... .._._..... . ' Final Inspection b J ............Date .. ..._ ............... i FH 13 24 1-68 fi[ev.z 5ji SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M i