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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -� Permit No—" .............. ............. lCanplets.in Triplicate) _ ... Date Issued This Permit Expires 1 Year From Date Issued 1� � Application is hereby made to the San Joaquin Local Health District far a permit to construct ands instal! the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: !/.fr�khr�. :.... ..CENSUS TRACT --•---- .................. JOB ADDRESS/LOCATION .. I:. ._ .- ; � _..., �r -•.. - ' ..Phone ... Owner's Name ........---•--•.............................. " Address . = -- -------------- ..............City ...'/�L / .. ..... �// Contractor's Name ........... .. {f! ..........:........License i@� !. .... Phone�T Installation will serve: Residence In Apartment House Commercial oTrailer Coit 0 'r Motel Q Other ----------------............................ : ,/.� 4- Lot Size a •� -"-� •--- Number of living units:...,.... Number of bedrooms S. ....__Garbage Grinder. r Water Supply: Pubis System and name ....... ...................__{...:.::.........................................................Pr ivate Character of soil to a depth of 3 feet: Sand O Silt Q Gay 0 'Peet❑ . Sandy Loam 0 Gay Loa MIX i Hardpan 0 Adobe 13--Fill•Material-............ If yes,type............... ............ ` r in sine of lot location of system in relation to wells, buildings, etc. must be placed on reverse side.) (Plat ;plan, show g 1 NEW'INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ]. SEPTIC TANK[ ] /f .. Size................................................ Liquid Depth . T f` motor i .. No. Compartments ................ Capacity Yi7e a!. E Foundation ro ne Disijance to nearest: Well .................................... _....._.....-----..... -•--•--...__.... p• i LEAC14ING LINE [ ] No of Line's ..:........ ...••...... Length of each line.................... Tat l Length ....----•-_---•---..._... a ' Depth Filter Material � ��✓ 'D' Box' .�e�._.."...IType Filter Material .................:.�-r-_p.. •--------......__.......------...-----•----- � 'Distance to'Pearest' Well ........................ Foundation • - ---........ ....... Props . . No _ P Line •-- .:_1--------------- Diameter Number ... Ye � SEEPAGE PIT T"[Y].-.•.- T-Depth `5� ................ -•---------:,...._....... Filled s �C�` = t �� a 1f } Water Ta - .............................. Size ................................ Table Depth . Di .. Pro Line ........... nce-to-rtearest:-Well .Foundation P• REPAIR/ADDITION(Prev. Sanitation Ifermit ........._......_. •- ...... Date .. ...............................► ° Septic Tank (Specify Requirements] --.. .............- ----- .... •................ .... . ' .. � -- ...------ Disposa) Field (Specify Requirements .s ..... ...................... ................... i �, -' ............................................................................................. ---------------- --------"------------- -------------- ---------------------- i (Draw existing and required addition on reverse side) �.. 1 hereby certify.that 1 have prepared this,application and that the work will be dome in accordance with San Joaquin County Ordinainces, State Laws, and Rules`-and Regulations o-1k If the San Joaquin Local,111901 h;District. Home owner or lieeet- sed agents signature certifies the#ollowing: '�' ` t "I certify that,irithe performance of the work for which this permit is issued, I shalt not employ Any Parson in such manner as to become subject to Workman's Compensation;laws of,California- Signed - ---- =-------•- •- ----------- -------------------------- Owner I 3itle A � --•--- ................. (If other than owner) FOR DEPARTMENT tlSE ONLY _ . 7` /-_ , --- -- --- --------------•- •----.APPLICATION ACCEPTED BY ...... DATE 4 BUILDING PERMIT ISSUED --------------- ---------- ".._ •-•---•• ....................................-.-DATE ADDITIONAL COMMENTS "" -........ ,... ----•••..... ......... -•------------------ --------------- -• __.�... -_�" .: w ----------�'-- .. --• .... ... . .........• -----•-- Final Inspection by _Date 7-3,4- - �_- EH 13•.24 1--68 &V, 5M SAN JOAQUIN LOCAL EALTH DIST ICT 8/74 3M a k