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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .:'..r SCJ_.C1............................ (Complete In Triplicated Permit No. ..................... This Permit Expires I Year 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 complianceith County Ordinance No. 549 and existing Rules and Regulations: JOS ADDe2/ o i2ESS�LOCATION ........./.....--••��•------ ---- --- ��.----•--•---•--------.......................CENSUS TRACT ............ ............. Owner's Name ._ ..............I.......I.......:....:................Phone ...`�� Address ..................§ c ® tf` a/ C1 ------ City .............. Contractor's Name � *.._ � phone .. .7.._ -•.. ........ ......... ........•-----.License # ................... Installation will serve: Residence Apartment House Commercial flTraller Court 0 Motel ❑Other........................................ [umber of living units:.... Number of bedrooms-- Garbage GrTder six .............+ r � Water Supply: Public System and name ...__......Private ❑ Character of sail to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam M Hardpan [] Adobe Ik Fill Material ............if yes,type............... ............ (Plot plan, snowing 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 TREATMENT [ 3 SEPTIC TANK' Size._. 0 c ` .............. Liquid Depth 4 Capacity _.1.x.0 ....... Type PZY-nd� Material. s ..... No. Compartments .......... r Distance to nearest: Wel! `......... Prop. Line _ ......----------"S Well ..............Foundation ---��•--- ,�`•4 LEACHING LINE 64,_ No. of Lines . .... .....:.... Length of each line...... Total Length ........ ............ 'D' Box 4_-. Type Filter Material -�4r,,,Pjl....Depth .Filter Material .../S // Distance to nearest: Well �cZ� _. Properly Lin® -------------•--....�1. Fou. dation -_� ........._.._-. ..... ....�..........� SEEPAGE PIT Depth _o`Z-.f_f Diameter ....._-��.-..... Number ...___�--�-.--_---- Rock Filled Yes,9( No iQ Water Table Depth 611... ...................Rock Size R Distance to nearest: Well .. .�. !:.....................................Foundation _ '.---... Prop. Line ........ ....... REPAIR/ADDITION(Prev. Sanitation Permit# ---_------------- . ..,-------. Date ............._........•...........) Ci Septic Tank (Specify Requirements) ...................... Disposal Field (Specify Requirements) .-•------_----------- .......................----------. -_- ...............................__......--......................... ---•----••----•----- _----------------------- I ..................................................................•........ i (Draw existing and required addition on reverse side) 1 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 Sari Joaquin Local Health:District. Home owner or licen- sed agents signature Certifies the following: "I certify that ie the erformante of the work for'which this permit is Issued, # shall not employ any person in such manner as to beta a sub e t Workman's Co pensation ! ws of California." Signed .' `- = - z� -. _.._ tw nem By .... ----• •-------------------- fitti ¢� --_. 0 ! ...... . e .........................., -��.� r� (If other than ownerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ._. .. .- DATE 1.-.2. e._______________ BUILDINGPERMIT ISSUED -------------••- ----- ---------------. ----------------- -••----•--•---•-------------------- --- --DATE . ------- ................... .ADDITIONAL COMMENTS ---------------------............... . .... ------------•------------------------ .--- ----------------------- -•--- ...... -- -�. ._.._.- •-- Final Inspection by: _.__....- Date .. -... EH 13 2h 1--68 Rev. 5M SAN JOAQl11N LO HEA!_TH DISTRICT 8/7a 3M