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FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT 6 Permit No. ............... (Complete in Triplicate) _ ............:..:.........:....................... ....: 3, y� Date Issue ............... .. ...... This Permit Expires t Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thea work herein described. This application is made in compliance-with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .........CENSUS TRACT,....,..................... ' Owner's Name e . .... ..... n Address . _..... - .. ...0 ylf1. :�'.�...�d ............City ............ //.JJ......... 4.: / �j { 1 Contractor's Name ---. :_..� ...License #, sl�.3 Phone ...��..:�fd�.s+ i. lnstollation will serve: Residence Q Apartment House J—] Commercial QTraller Court Q i Motel ❑Othert..� ��.1__--::.- Number off living units -. . -....... Number of bedrooms Garbage Grinder ............ Lot Size ..... Water Supply: Public System and name ............. .Private ❑ 1 Character of soil to o depth of 3 feet: Sand:n.._.Silt Q Clay 0,-Peat 0- .;Sandy Loam [). Clay Loam j] � 6 Hardpan 0 Adobe Fill Material ............If yes,type ............... ............ (Plot plan, showing size I;of lot, location-of-system in relation to wells, buildings, etc. must be placed on ;reverse side.) NEW INSTALLATION: (Na septic tank or seepage pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT (j] SEPTIC TANK Size...... .e1 .. Liquid Depth ._. , �........_ Type .-. - �":. Material... .. ----- No. Compartments. � -- ........ Distance.#o nearest: Well ...- ---- .............•-Foundation .---./0.......... Prop. Line................. \V X LEACHING LINE No. of Lines ..__.+ ........... Length of each lin e-� .--.A0....... Total Length .., /. .............6 f5%ry✓y D' Box _r.. Type Filter Material. .f ..Depth Filter Material .....� .......:...................... i .: ..... ........... . Foundation Property istance to nearest: Well _._�'............. ....��.._....---.. Pro a Line SEEPAGE PIT �( Di r rr D ep#h .� ------•__-. Diameter .. :__-- Number -..---.- -..... Roc Filled Yei)RL No rRo �.X Z € S � Water Table Depth .......� --------------- ........ ..�.._ ck Site •.� ..... .... r x f Distance to nearest: Well ... ..Foundation � .r ...-. Prop. Liner .=. ...- REPAIR/ADDITION(Prev. Sanitation Permit# ---......--•..... ..... ..........:........ Date ...................................I a Septic Tank {Specify Requirements) ....................,.`.�`` -----. ......................... •----. ........ ............... ,........... .......... Disposal Field (Specify Requirements,...._ =_ /�'l....... ..-...... .-••.. { - ------ -'---- ..� d---- --- - � ............... .................. ... ... pf I. . ��-- p (Draw existing an 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 and Rules and Regulations of the San Joaquin Local Health:Dlstriet. Hoene owner or licen- sed agents signature certifies the following "I certify that in the performance of the work for which this permit is issued, I %half not employ any person lit such manner as to become s i t to Workman'sompens tion laws of California." Signed .....- -- --- ----....-..... .._ Owner s Title -----------.......... - c --BY (f er than owner) - - . } ,.0 � FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED, BY - z : . DATE . ?� ?�........ . . BUILDING PERMIT ISSUED ---------------- . .-.._.._..-_-----------................................---•------------.....-..------.DAT .......-..---....---�--.....----•--......_-. ADDITIONAL COMMENTS -._.-.... -:. : :.` -- ;r--- ---- ---, -- - •-------------- ----- - .................................. . . .._ ... .-•-- .-.._.-_..-.__.-.. ..-. I -- Finai Inspection b ............. ........... ------------- PY :_ -------•--• --I--- -------------- ©ate .. ��.----- ---•----- E;H 13 2h 1--68 Hey. SAN JOA-QUiN_ LOCA!` HEALTH DISTRICT 8I?)! 3M 4