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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No,-,........��-•-= _...........�__.._... (Complete In Triplicate) Per..._... _... --------------- -----..-.------. ------•-- - Hate Issued . :7:t_� This Permit fxp Ires t Year From Date Issued 5 ............ 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 OrdinalNo. 549 and existing Rules and Regulations: �'.... Cl:CENSUS T I 5S/LO TION ....... _. _..7 ........., ...:......... JOB ADDRESS/LO :..-.&..... -7 ................ .......Owner's Name City on I ....� ... ................:..... .......... - Contractor's Name ....license # ........................ Phone 019... --... installation will serve: Residence RApartment House] Commercial ❑Trailer Court ❑ 1 Motel ❑Other ...................:........................ * i d K...�: � Number of living units:... ........ Number of bedrooms Garbage Grinder ............ Lot Size .� .•.-...-.• . •••••• Water Supply: Public System and name ...Private ❑ Character of soil too depth of 3 feet: Sand❑ Silt L7 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam' Adobe Fill Material Hardpan ❑ ❑ ..---....... W yas,type ...........:... ............ J Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) E ( P g . . NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) Size._�j _�..�. 4.5..�..__..:... Liquid Depth 7....---• PACKAGE TREATMENT 1 ] SEPTIC TANK f ] , 1 "' '""' /°Z YP `C Mater:ai.._.....--, ' No. Compartments i CapacityT e Ce'K-... -- •-••................. ---- -- , b ----•- Prop. Line ..?r....:..........x� Distance to nearest: Well __ �..----` -••---.... n .............. i ..Foundatio00 ! __ LEACHING LINE No. of Lines �g------ ----- Length of each lin �_ ..... . Total Length .-- �•�!• �. .�-_/WL • Y1Cdl1c •~ D' Box ..---�..._ Type Filter Mater) ...................{Depth Filter Material ./...z.....• --• �, , ',: Distance to nearest: Well ... ........ . .. Foundation -,P................. Property Line ... SEEPAGE PIT Depth _ -25----------- Diameter 3------ Number -----/F...............••... Rock Filled Yes, No �❑ Water Table Depth -•---•--._....... . I?-- ------ .•-Y-Rock Size ... ........................... /. / 0 f t. —.-Distance to nearest:,Well �a�.. .... T......-- Foundation .../.40...._.. Prop. line ..................... I EPAIR/ADDITION IPrev. Sanitation Permit# ----------- -----------• ----•- ------ Date ...:......................,....... } . ,o'� Septic Tank-.(Specify Requirements} __.:_-•-- ----....... ......:..........•.. • !i # 1 Disposal Field (Specify Requirements) --------------------------------------- i--•-•---.....:.....................................---.................._...------- ...:.� I �- ------- ------- ---------------- ..........._.........__... ...... •---- ---- _ ...... ........................................................ . (Drcllsting and required addition on•reverse side) I hereby certify that I have prepared this application and that theworkwill be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and'Regulations of the San Joaquin Local Health.Dislrict. Home owner or Ilcen- k 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 becom' subject to Workman`s.Comp' ns tion laws of California." f -------------------•- Owner Sibned ----------A ---- _ ..................... Title - -------- ..................... . Jif other than owner) IPARTMENT USE ONLY .DATE APPLICATION ACCEPTED BY ____ _______ ___ _ .......-_..... BUILDING PERMIT i5511ED ..-_.-.-_•--- -`-��---•--Y--- � _ • ,": . --.DATE .... ADDITIONAL COMMENTS __... .�/_:::::�-------- . . ---...--. - ---------.............--------- ---------- ...... ------------_---------- -•...._...... ......---....--•--...............---•...... F .................... ...............••---------•....... -- -----......-."-- --------------•- ------ • - -- ._...- _-------- --------- ----- ------- -.. . .. •------•--•--------- ---------------...............................---.._...- ?a..- Final Inspection by: .............------------------- Eli ..... ........ .Date ..._ . .. El1 13 24 1-68 Ziev• 5m SAN JOAO N LOCAL HEALTH DISTRICT 8/7h 3M