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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. n Date Issued . .......-................4^-to ............ (Complete in Triplicate)______________•........ ..._.__........... 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 made in compliance with Copnty,Ordinance Na.•549 and existing-Rules_and R ulptions. JOB ADDRESS/LO ATION ...._<..5 ----- as.ynm.elo........................... ..........................CENSUS TRACT -........ ............... . Owner's Name 0-71._Aaoa.r�t�— ...............................................................................n...•......Phone Address ..'4_.5_We __:"3��,axr -........................... ............ City . i?ISI.r. +! 41. ............................ ....... .�..q�. _., .....� .. ,.._ . .. - Contractor's Name ---- .-----.......................................................License #_Z2.3'.,-5-/(......... Phone ......... Installation will serve: Residence []Apartment House Commercial Otrailer Court Motel ❑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❑ Clay Q", Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe 0 Fill 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.) NEW INSTALLATION: (No septic tank or seepage .pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENTq r { ] SEPTIC TANK I ] Size...1�.X_A:5-=--------------•..---:------ Liquid Depth .................... Capacity _fa _ ___ Type -------------------- Mister€all; .--._.. No. Compartments ................� Distance.to nearest: Well _fes _________••___•_..Foundation/4Y ---------... Prop. Line _11 Q , :.._...... , LEACHING LINE [ ] No. of Lines ________________ Le gth of each line.._. -._ ._.n4....... Total Length 'D' Box ____________ Type .Filter Material ..1 .� ...._.....Depth Filter Materia! _/.z1.�I./Sd�........................... _- . T ..Distanceto nearest: Well ��UEI Foundation '..'.�..:"-�. W SEEPAGE PIT Depth ------------------_ Diameter ..........:..... Numbi r'-•----.:-:'__...:.-.::: Rocic�Filled Yes ❑ No C3Water Table Depth ---------------------------------- .............. Size ._.......... ................... Distance to nearest: Well ........................................Foundation ------------------ --- Prop. Line ___..... ...... ;00! REPAIR/ADDITION(Prev. Sanitation Permit# -..-..-.....-------------------------------- Date -------_ •-----..•._,_. _) Septic Tank (Specify Requirements) ________________ Disposal Field (Specify Requirements) �6 .........G-----... --------- -._.-_, ---,-,-,-. ..-•----••......:........1,.....--•---•--~_:ti ---------------------. ............ .......•.................. . ------------------------------------------- --------------------------------------------- ----- --___-------------•----------••-----•-------......_...........-,_-----•--• (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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Horne owner or licein- sed agents signature certifies the following.- "I ollowing:"I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's-Compensation laws of California." Signed --------------- Owner�j BY ------ •-----------------•-------,--. Title Sq+ .WIQ-�.. s .............. (If other th owner) FOR DEPARTMENT LtSE ONLY APPLICATION ACCEPTED BY ------------- ------ DATE Q:- .... ---- BUILDING PERMIT ISSUED ------- ---_-- ------DATE ------------------------------------------- ADDITIONAL COMMENTS -.........• --------------------------------------------------- _ ..... -------------•--•--------------=--- _.. -•-- ..----------•--... - Final Inspection by. _..__ ........ _Date —2. ` ........ { EH 13 24 1-68 Hev- 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M