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K'R vrFtue MCIAPPLICATION FOR SANITATION PERMIT ....................... .............. IComplete In Triplicate! Permit No. ...7�._.�Qsf ....... ............................................... Date Issued /�- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr id and Install the work herein described. This application Is made in compliance with County Ordinance No. 549 and existing Mutes and Regulotionse JOB ADDRESS/LOCATIO _ 111 . Le tt!j._r '1� ...CENSUS TRACT .......................... Owner's Name ........I...G l ...._ ./_eq„ -• ,fit."✓..--...4 .. .Phone Address ......................................................................................................... .......•---•....--------........./............ Contractor's Name � ,. :,-F • ..................................... 1 �.1.. � �Z �"`�..4... -� '�j (,.�.�. �... ..L cense# Phone � Installation will swrve3 Resldence p Apartment House 0 Commercial 13Trollw Court ❑ Motel ❑Other............ ............................... AC Number of living units:- -{--•... Number of bedrooms ..�,1�.....Garbage Grinder ............ Lot Size .... j-�...:.:......................... Water Supplye Public System and name .........................................................._......._ ...................................Private Q� Character of soli to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam C] day Loam YP Hardpan❑ Adobe 0 Fill Materlol ............ 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: iNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) z i PACKAGE TREATMENT [ ] SEPTIC TANK ] Si:e...�< ; ..bl-A......... Uquid Depth .. ................ Capacity�& " ... Type .1 !�E.C'� Material... ................. No. Compartments ....................lit Distance to nearest, Wel' A Pe..59'.?. .. n.Fovndation % ............... Prop. Lines . ..... �EACHING LINE [ ] No. of Lines ... ................ Length of each Ilse-.. ............... Total Length ........... 'D' Box ...?....... Type Filter Material ./ ,i� , ,Depth`Miter Material ...._ ... - , Distance to nearest, Well :... ...... Foundation .... Property Line ........... { SEEPAGE PIT [ I Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Water Table Depth ----•-•-•----•-•.............................. .Rock Size ........................... Distance to nearest Well ....................................`. ..Founddtlon.'..........I....... Prop. line .................... REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date .................................. ] SepticTank (Specify Requirements) ......................................... .. ..................................................••..............._...... Disposal Field (Specify Requirements) ---------------------•---•-------------------------------------•-----------------------•-..........--..._...............................--•-•---............•--._.._._......................-••...... (brow existing and required addition on reverse side! %. I hereby certify that 1 have prepared this application and that the work will the done in accordance wish Son 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 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 become sub actto�rk 's Cqp3ponsatlon laws of California" Signed i .=.P :. ' `�....... .......................... Owner By •.... ............. hew . title ......._................................_ •.............. (If otr than oner! adq>< REEPTM INT USE ONLY x APPLICATION ACCEPTED BY ......... DATE. ...., a`J � ....... BUILDING PERMIT ISSUED ......DATE.....................•--......------------.. ADDITIONALCOMMENTS -..... ....... .. --•-•---•---.. _...._.................._................................---.....••--...__..._.........--- . a ................... .. .......... .................................... Final Inspection by: Date :...: .... ...... ......................................•-• .....--- .... . iH �3 24 1-68 Ncty. �m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h ]M