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EOR OFFICE USE, APPUCATION I�OR SANITATION PERMIT- ..... 7C lComplete in Triplicate) Permit No. ...••-•-.•---•• Date. _ ...................................... .. - r Issued _ -- 4- - ,, ::-Tfil-- Pennit-txpires 2-Year-Eram 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- JOBj ? - ADDRESS LOCATION _ cr��C, .... ..... ...................... ..........CENSUS TRACT' .................... Owner's Name ..� .... '...Phone . . Address _C€ �-.r�,3.9. _.. . _ Contractor's Name .License _.� ,'�� ' ..... ..._.._ -- Phone Installation will serve: Residence 0 Apartment Houser Commercial ofraifer Court r E Motel V'&her'................................ ' ...... Number oof living units:... Number of bedrooms ... .Garbage Grinder Lot Size t Water Supply: Public System and name ....:....:....... a •.........................................-------....._....._--.... o ............•............Private❑. . Character of soil to a depth of 3 feet. Sand El Silt 0 Gla E Peat❑ Sandy Loom 0 Clay Loam,o - 4 .Hardpan Q Adobe Fill M6terlal .:.......... If yes,type )Plot plan, showing size of lot, 1�cation�system in relation to wells, buildings, etc. must be placed on reverse side.) ,NEW INSTALLATION: (No r+ se tictank-osee p + � page pit permitted if public sewer is available within 200 feet,) � PACKAGE TREATMENT.:...[) . .SEPTIC TANK)f l Size----------------------------- ......... Liquid Depth .................._... O G Capacity .__.-_--_---.----- Type •--- Material.---------_--- -_ No. Compartments Distance. to nearest: Well ------•.............................Foundation ................ Prop. Line o.......__............ LEACHING LINE [ ] No. of Lines ------------------ -- Length of each line............................. Total Length . 'D' Box ------------ Type Filter Material ....................Depth filter Material ...-•.............................>......_.. I Distance to nearest: Well ........................ Foundation >,---------........------ Property tine ........................ �. SEEPAGE PIT { ) Depth .............. Diameter Diameter ..........: Number ............................ Rock Filled Yes p No 0In Water' able Depth ------------------------------••------ --•---..Rock Size Q ................................ Distance to nearest: Well REPAI ..:............Foundation Prop. Line It/ADDITION#Prey. Sanitation Permit Date .._................•---•----.........-- -- .................) Septic Tank (Specify Re uirements fs fY q ) - •------ Disposal Field (Specify Requirements) --------- ------ _•-- : - •--•-- �ja 5� R \ 1 -----------t---------------- - a-•-•----- -- --------- -= (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 Locat HOW&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 subject to Wo an'sll ensa n laws of California." Signed -- ...... ....... Owner BY f Title _. ( othe than a I - - l - - -- .-..-. _... fi FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- - .. -- DATE '.-. .'-..-- -• ...6- BUILDING PERMIT ISSUED -------- ----'-----------_ DATE ....... ADDITIONAL COMMENTS ----------- 1 ............ � . -- ........... --• ---------- - -----•...................._. .--..--- --...-----••---....-------------------...-..---- �, ----- ----•--•---....--.-. ----------------------------------------- ... _ .. . . _ fO Final Inspection b I _ Y= -•--- - --- ----•-••- - - ---•-----• •- ----. ... .._ _ ... ----------------------Date -...--- EH 13 2h 1-68 Rev. 5�1 SAN .-r , y JOAQ IN 8/7� 3MLL HEALTH ©1STRICT ;