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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT C_-2y S ......................................................... Permit_ No. ............_........ (Completo In Triplicate) ..............:............ ..�.._.., Date Issued ......................................................... This Permit Expires 1 Year From Dato Issued 3/7- .. Application is hereby made to the Son Joaquin local Health District for a per to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- J013 E - ADDRESS/LOCATION��...--, - . �/T�. ............. .Z. f� CNSUS TRACT .., .............. .V Owner's Namee ...... .------------••---.....----•........................... Phone x ',, Address --------- •= • it .�. . • --•-----••-. City ........................ ..........................-.---------- / Contractor's Name . - ------®. rA s---- .., rir. .License #-—6.# :.!qI�- Installation will serve: Residence Apartment House Commercial❑Trailer Court ❑ II Motel ❑Other............................................ Number of living ani#s:_..!______ Number of bedrooms -Z......Garbage Grinder t./. Lot Size ' Water S6ppiy: Public System and name ........................................................_....................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt O Clay ❑ Peat❑ Sandy LoomX Clay Loam Hardpan l- Adobe o Fill Material ............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: (No septic tank or seepage pit.permitted if public sewer is available within 200 feet,) PACKAGE �..W TREATMENT [-3 SEPTIC TANK•j,!�. T 1f7F/ "'•�ize._.::: �------------------- ---- Liquid Depth � - Capacity - �._..... p 4A Material...................... No. rCompartments n Distance. to nearest: Well .•__-s?C� -....-.....- .Foundation/.10.71.... .. Prop. Line ...... .� .J LE CHING LINE [ ] No. of Lines -.-J------ Length of each line.......7,Z........... Total Length ...7J—/.............6 -- 'D' Box ..._..-..... Type Filter Material/::4-01ADepth Filter Material ..Z.Yqf:re............................. %n Distance to nearest: Well .....S-0.7`------- Foundation .....r'.a.f_.......... Property Line ....4�.- ............6 -SEEPAGE••WT [ j �=------------------ Dttrrrsefer .............. hun+er .-------------- 0 th ------------------------------------------------SIE-si;e ...............................DWonee ell -----•--------••--- ................Fc atatkul-----------------•-- Preppr.-Ufie-.................... REPAIR DD1T10N(Prev. Sanitation Permit# ...... .....................�.........._ ote ................ .................. ) Septic Tank (Specify Requirements) - . .�r .�......--•----------------- ........ ....................P'a Disposal Field (Specify Requirements) ________________ I ' -- ------I-- -----•••----------. .. -- ........... --------•- ....... ..................... .................... ----------------------------------------------------------------------------------------------------- t. _............................. ........................................................ (Draw existing and required addition on reverse side) s 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.flistrict. Notre 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 Workman's Compensation laws of California." Signed --- ---------- Owner B .1'�f.Ve ... Y �os +� ..... Title ----------- ------ jif other than owner) ' FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ----- DATE --3-- .- - - -- ---_ ------------- BUILDING PERMIT ISSUED --------- �- --.DATE .......................................... -- ---------------- ••-.------- ADDITIONAL COMMENTS ._ --------.........................:........................... -------------------------------- - ------- .._...-•------•---------------------------------- ---------------------------11 ----•-- ............................................ Final Inspection h .............................Date -- - 7 ---•---------•- EH 13 2h 1-68 v. I SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M