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FOR OFFICE USE: APPLICATION FOR SANITA'T'ION PERM .....................................:-•............... r o ...................................I........... ...._.... lComsplete.im.Tripiicatef Pe mit.N . ..7�..54� .............................................. This This Permit Expires t Your From Date Issued 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 ADDRESS/LOC ATIO I. 0�... !W....._• P .. CENSUS TRACT ........•-----•-----..._._ . ..----. ... ............... Owner's Name ........... ........... -�"1 -....... _ ...:_.._-.:...: -Rhone _ .�Cd'` '-3�f � Address ..:............._..1.�.�T ._._ 'Id.:._.L-4��- -s....r.+__�'�..._n ....City _._..: ... G[c" !..-----------...--....-.------ - -------------- ame c� a -Q_ Contractor's N _- --- !................:.:........License # .5`f~ J.---- Phone Installation will serve: Residence 0 Apartment House Commerdal pTrailer Court 0 �t Motel Q Other Number of living units:............ Number of bedrooms ........:..-Garbage Grinder .... Lot Six®~-- ---------------------------------- - Water Suppjy: Public System_ and name t .................................... .......Private❑. Character of soil to-a depth of 3 feet: [Sand o S€ltlij Clay [3i Peat Q Sandy Loam 0 Clay Loam ❑ it � Hardpan[j Adobe El Fill Material ..... ... If yes,type................. 4. ..... lO �l e + (Plot pian, showing size of lot, location of system In relation to wails, buildings, etc. must placed on reverse slde.)*"k F NEW INSTALLATIONe INa septic tank or seepage pit permitted if public sewer Is.availalble within 200 fee,) Q" - •-= •------.. U uld De -- - PACKAGE TREATMENT .(ai_,_SE TIC TANK I ] Size............. q ' ia#h •-----------.._... .- - Capacity Type Material_.. ...__..... No. Compartments ----------------------` ---•----�---•--• ---•..........:..... X11 Distance:,to.nearest. Well .......................�..i..--Foundat€on ..._.:....._........!Prop. Line ------_--------..!_...� LEACHING LINE [ ] No. of Lines -- 4 ' .'' Length of,.each line--- c..,I Total Length ...................... 'D' Box 1> . . Type.Filter Materiai� ...Depth Filter Material w � ............. — Di'starice to`nea st: Well ....... Fouridation Property Line --------_-------------- SEEPAGE ------ - ------------ SEEPAGE PIT [ ( Depth ......... Diameter .__-. .......... Number ............................ Rockfilled Yes 01 .�.No„0 Water Table .D p .__''._..Rock Size .. Distance to-n a est. Well ...... ...........l............ ...�....Foundation.r.:: .::— -Prop. Line------_---..-------- . r. r,Iti:PAitt/ADDITION(Prev. Sanitation Permit# _.. Date .___••............................) , ................. 4Septic Tank (Specify�Requirements) ..................'-- - ------------------........................ ......... .....-•----. -_-:..... Disposal Field Specify Requireme its]' �[1 .. ............................................... �_ .-' S _- -f------ . 5xiting-In'-8 ....... .. 5. .................. ... (Draw.. required addition on ire erre side) Q 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 Son Joaquin Local Health:District. Hance owner or Ilcea- 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 beco... . subiect to W ma Co�pensation l r s of California.” Signed..... . ...�....._.. .-- -`--•-- ._._:....---- �- r OQ4fi� BY -----• -- - ----- ----------------- •----- ----•--.._.--- ...__. Yit a ----- (If " - _._........._.._... oth tan owner) t FDEPARTMENT' 'USE ONLY APPLICATION ACCEPTED BY --- --- -- -------------•- ----------------•---------- -.------------=------ DATE /L_ ^- ! •----------- BUILDING PERMIT ISSUED -- ------------ -- -----------------•----•---- -------DATE .- - -- ............. ..------•-----•---- ADDITIONAL COMMENTS ..................._._.... ........................................................- r .......... .......--••--......••-•.............................. ... ......... ....................:...... i ----•....-'••--------- ........ ............................. ...................... - ---------------------•-------- _. Final Inspection b �_. __-_--- Date EH 13 2h 1-68 IieV. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M