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FOR OFFICE USE: - - APPLICATION FOR SANITATION PERMIT ........................... q (Complete In Triplicate).., Permit No. ... ..p .............. • .. ._..........._... This Pen it Expires I Year From Date Iss.ueel 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. 549 and existing Rules and Regulations: JOB,ADDRE§SAOCATIOiV��.��&!� . Q_ !1 .C�- Owner's Name [ ----- . ...................Phone _ ••--...I........... Address .....?..........._.. .._ _.-....... .. ............. ty C€ ._..... . . .... --_. Contractor's Name.= .._ ...................... License .Z.l._ 2 __ Ph ne ........ Installation will serve: `• - Residence Apartment House Commercial �� 1?17 SAI c T xiv"htO ` p fl ❑Trailer Court ❑ . E._ otel ❑Other s. ............... --.... { M �� `x1 Number of living units------------- Number of bedrooms --- --•:.Garbage Grinder kat Size .. ---- ... Water Supply: Public System and name --- 1.4M1 ........w....... . .!V ...........................................private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt El � Clay Peat❑ Sandy Loam ❑ Clay Loam [] • Hardpan❑ Adobe❑ Fill Material ifea i y type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: I (No septic tank or seepage pit.permitted if public sewer is available within 200 feet,) ' s PACKAGE TREATMENT [ ] SEPTIC TANKy Size._..1.�•Q� � ] Liquid Depth .......................... Capacity .•.................. Type '-- Material. 'No. Compartments� , ....._r Distance to nearest: Well Lt..l::__........Foundation .�(�___•--........ Prop. Line .._ LEACHING LINE [ ] No. of lines ............. Length of each 3line.._-..... --._-. Total Length 'D' Box -:.... --. Type Filter Material ._ pth Niter Material .....�� .............................. r / Distance to-nearest: Well ...L- ..._.... Foundation y�.....�-�c.......... Property Line __ ............. SEEPAGE PIT [ ) Depth _-.-_--_-__------ Diameter ................ Number ............................ Rock Filled Yes ❑ No❑ -C" Water Table Depth ............................... ................Rock Size ...-----......---- ........ O Distance to nearest: Well ......./ _..Foundation ...... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# _-_......_.___.__._-�,=••.............•---- Date ....-......_._.................... ( ' I Q Septic Tank (Specify Requirements) ............................ ---•----._........---.....-----.._..............._.__......:... • '? , Disposal Field (Specify Requirements) __ 6 . ----•••-•....... ...........•-••-•----...... ....---•--••--•-••-•-•... O ' ---------------------------------•--•----..•........... ----------•-•----............----•---------- - ................. (Draw existing and 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 Joaquln� County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District.Home owner or llcm sed agents signature certifies the following: "I certify that in the performance of the work for'which this permit is issued, I shall root employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ................ .--...._...:......... Owner BY --- •---- ------•- - Title 1 � (1 her an ownerl F -DEPA"ME T ONLY APPLICATION ACCEPTE ) 13Y -.- - - --_---DATE .. - ........ -: BUILDING PERMIT ISSUED ---- - -- --- _DATE .... ADDITIONAL COMMENTS . - � •. f -- •--- f ......................... ----- --- r; ---------------- �; ; ---•- -- ....- --------Final Inspection by: .-- -- :------- --- ---- .------....--......--...............-.-Date F -- .......-- 13 21� 1w68 v, 5 iSAN JOAQUIN LOCAL. HEALTH DISTRICT 8/7h 3M