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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -�`3.. a ..... This Permit Expires 1 Year From Date Issued ©ate'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. 544 and existing Rules and Regulations JOB ADDRESS/LOCATION .......- J-:: - .._-......_ ...... ... * . CE ACT ................... ... Owner's Name ..... .. NSlJS .TR ,. . . . -..-. Phone ........................•.... ... - _ .... -- ... . Address ........ -------- `.._. . City .. Contractor's Name I - -- ----.,.................••--•--..........---- r - � -a� �1_ � ,-,License #��7.�77' Phone Installation will serve: Resiclence Apartment Houseo Commercial oTraller Court ❑ Motel ❑Other t Number of living units:_. Number of b rooms _____.:Garbage Grinder Lot Size . + e.... , I .... Water Supply: Public System and name - ._...... •-•.....................•.•-•--...:.....Private ❑ r Character of soil to a depth of 3 feet: SandSilt "Clay f n Q [ Peat Q Ai le Sandy Loam ❑ Cloy Loom ❑ S Hardpan 0 Adobejk Fill Material Ifyes,type ........... .. U (Plot plan, showing size of lot, location of,system in relation to,wells, buildings, etc. must be.placed on reverse side.) i NEW INSTALLATION: -(No septic tank or seepage pit permitted if .public sewer is available within 200 feet,) PACKAGE TREAT MENT [ ] SEPTIC TANK{je/e S_rq( ' A e- -------------••-------------•-_- ---------- Liquid Depth -- Capacity ..::........... Material----------....--_----- No. Compartments + TYpe -- Distance to i nearest: Well ----:•--------------------------_--Foundation -------.--------------- Prop. Line ...................... �i LEACHING LINE , No. of Lines .. -------- Length of each ine._..4--w.... ............ Total Length X.. 'D' Box ------Depth Filter Material ��' Type Filter Materia! .................. ...... f Distance tonearest.-Vell . `-L ---. __ -. Foundation -fa---I............. Property Line ... . ..... ' SEEPAGE PIT Depth .1425,397_.....E"Diameter ,IZI_-Number ............................. Rock Filled Yes No Water Table Depth .... �,� .............................Rock Size -_._ = Distance to nearest: Well .. "_ ----- .. _ -.-Foundation ._��---..-_-- Prop. Line .... ------ � REPAIR/ADDITION(Prey. Sanitation Perrnit# ......:............... ........ -.. ............ Date ......1— w Septic Tank (Specify Requirements) ................-..._ ..... :-: .......... r •-.--- P Disposal Field )Specify.Requirements) -- R i ` - r` ..... 1____, - ............. -------------------------------------------- - I� 4 (Draw existing and 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 Laws, and'Rules and Regulations of the San Joaquin Local health District. Home owner or liven -. sed agents signature certifies the foilawing: "I certify that in the performance of the work for which this permit Is issued, I shat] not employ any person in such manner _ as to become sub)ect to Workman's Compensation laws of California." Signed ----------- -- ---• ------- _ Owner w By ------•----- 4 - - -- ---•• ......... Title ...... i •------- ------ ------------ of er than owner) . D RTMENT USE ONLY f BUILDING PERMIT ISSUED'..APPLICATION ACCEPTED BY_-___ - - .... ... DATE ---- --- .. . ...... .... . ••------••-•-•-•------••-----•--•---- ----- ------------------------DATE -• --=------•--..,._..---- A[5DI FIONAL COMMENTS , ,-... .__... -------------------•--•------------------------- . - --------- ---•-----• ..............--- -•-•----- ----•-•---- ------•---••- - .... I . ...............................................� -- Final inspection by: . _... .. . ............Date -_..f... EH 13 2h 1-68 < S JOAQUIN LOCAL HEALTH DISTRICT $/7M k � F E