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FOR OFFICE USE: � ; APPLICATION FOR SANITATION PERMIT L --•...................................................• Permit No. ./L '//3 (Complete in Triplicate) . F ,.. ........... .............. -----• �. , This Permit Expires 1 Year From Doto Issued Date Issued .................... Application is hereby made to the San Joaquin local Health District,for a per 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/LOCATION ss/LOCATION .._.... _� _. ....' _ •� ._- . ..�a �--.............cENsus TRACT Owner's Name ...... -•-•-••............................. :............. ..Phone . .�..a ._ _.... ..................•---•---.._._...--- Address .._......... .. ,,, ,.. ---- City Contractor's Name ---------------------- -i-•-------------- -..............................................License 9!f -................----..._ Phone ........... ---------- Installation will serve: Residence 0 Apartment House Commercial❑Trailer Court 0 Motel ❑Other Number of livingunits ..... Number of bedrooms Garbage Grinder Lot Size ... '��"� j--• ' ..... g _........... .... ....................................... Water Supply: Public System and name Lr. .:...............................................................................Private [:1 Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam ❑ Hardpan❑ Adobe 51 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,I PACKAGE TREATMENT [ ] SEPTIC TANK f } Size................................................ Liquid Depth _.._....._...._............ Capacity -- /L_®d-•• Type --••................ Material---------------------- No. Compartments ........................9 Distance. to nearest: Well .......... .......................Foundation ---------------------- Prop. Line ..... .....--.......� ` LEACHING LINE �4 No. of Lines ........- Length of each line..........G._,S............. Total Length •--. �--.sem.. ._... 'D' Box ............ Type Filter Material ,evf� �4:_.� Depth Filter Material ..........1. ............................. rn U� + Distance to nearest: Well ......SINS...... Foundation ........ Property Line —>:.g............ SEEPAGE >:.g......-•-•- SEEPAGE PIT [ Depth Diameter ---------------- Number ---......................... Rock Filled Yes Or No CIO Water Table Depth ----------------------- .......................Rock Size .... ........................... C Distance to nearest: Well __...Foundation .... Prop. Line •1 REPAIR/ADDITION(Prev. Sanitation Permit# .........................-.................- Date ..................................I Septic Tank (Specify Requirements) ............... ......................:.......................................................................... Disposal Field (Specify Requirements[ ------------ -------------------------------------------------------------- --- -- . . - -•--•-------- -- ._... .. - . (Draw existing an_ .d required additi.on on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Seen Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District. Home owner or licen- sed agents signature certifies the followings "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 became subject. o Workman' C mpensation laws of California." Signed .... .................................... Owner BY ---------------------------I------------ ... Title i (if other than owner) R D PARTMENT USE ONLY APPLICATION ACCEPTED BY ', - - _ /j^'- ------- •-- - DATE ._ .4AC --.� (�!7 �.------- BUILDING PERMIT ISSUED .--. -••------------- ... .....-•--. ..---- DATE ........... �...... ................ ADDITIONALCOMMENTS ------ - ------•----•---..................._.,....------.....-------------------••------------------------...:........------...._.:............................ ----------------- ----------------------------•------ ...............-...---- --..._._....---•----.....---•------ ------------------ ............. Final Inspection by: -•---------------------------•---•--.....-----.... ................................ /L-. Date -. .�t's..--•----------_....---- EH 13 2h 1-68 %--v. 5m SAN JOAQuIN LOCAL HEAL ISTItICT 8/7h 3M