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FOR OFFICE t1SE: APPLICATION FOR SANITATION PERMIT ....... .._ ,. �.. mArnplete In Triplicate)... . .. , ' _._.... .. Perm€t Na Date Iss ...................•........••.•......-- •--.... ued.. This PerntitExp€res 1 Veer.From 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 Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...............CEN5l1S TRACT Owner's Name .-. H }SI�� ._. f R .. ............. :....:. �6� - ..........Phone .....--•- ••', 3 • f Address ..._ a....._1 ...._..--•-• ................CityLi .M. �.hBO1 .. - --•-•...._. J Contractor's Name ...!_IrifN- E3---- ......License . Phone ....... ---------_ installation will serve: Residence g}Apartment House Commercial,flTra€ler Court 0 Motel Q Other / � ) Number of living units:-.-----•-... Number of bedrooms -•-?--.,...Garbage Grinder ..----_ Lot Size --1._...-.... Water Supply: Public System,!�and name ............................... Private Character of sail to a ds th of 3 feet: Sand Silt Cla .�. .................. i p 0 0 y ❑ Peat p Sandy Loam 0 Clay Loam 1p � Hardpan 0 Adobe El Fill Material if yea,type............... ............ (Plot plan, showing size of':at, location of system in relation to wells, buildings, etc. must be placed on reverse side-1 NEW INSTALLATION: (No ieptic tank or seepage it permitted if public sewer.is available within 200 feet,) f j PACKAGE TREATMENT ( l SEPTIC TANK I Size._ I O -X ...•--••-. 5 -•----- Liquid Depth .......................... Capacity l�q.._._ Type ECf� . Material..C.Q. No. Compartments 2---...'.._ Distance to nearest: Well ..... -,----- -- ..Foundation .�a............... Prop. Line _ ................ LEACHING LINE [o'J�No. of Lines :¢----------------- Length of each line....X%)-------_._.---- Total Length ./_7.0 ...... 'D' Box . ... Type Filter Material ..........Depth Filter Material _.� .....".....•..-------.•- • Distance to nearest: Well ...XL'_.-........- _ Foundation ..� ................. Property Line .....-•---.....-.. ' SEEP PI [� Depth /._ ........ Dis suer 1p '_�:�7Number _........�.............. Rock Filled Yes $} No ip j Wate Table Depth -.1. .Q...............•. Rock Size ./ -- •.... I. Distan ce to nearest: Well ... �.p ....Foundation 2__U............ .. Prop: Line •-----•--........ ---......... III:PAIR/ADDITION(Prev. Sanitation Permit Date __................................} SepticTank (Specify Requirements) ------ ........................................................................................................................ _ Disposal Field (Specify RAuirements) ........................................................ ,I ------------- ----------------------------------- -----•••--••---•------------ •-----•---------- �--------------.....------------ --...-•---------•----•--••-............ ........ (Draw existing and required addition on reverse side) " 1 hereby certify that I have #repared this application and that the work will be done In accordance with San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healih:District. Home owner or llcew sed agents signature certifies t�e 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'e t to W rkstman' Com sation I ws of Cal€farnla." .I Signed .. ------ -----------•- ----- .t , ............. . Owner BYI�.-. ................ Title ....... - ... --------....---... (if other than aHrnerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1M, __ - -- - •• -• - -----......................... ..__. DAT(= --- - -- --._.,.....-.._-: BUILDING PERMIT 155Ut b � ---------- ------- •-------- .................DATE -------------•-----------------•- I ADDITIONAL COMMENTS ------11 ----------- --------------------- - -- -- --- .. -.._. __. -•-•- - - ----...- 4 ---------- --------------------------------------•-•-------------- --- -•----------------._.---._....-------------------- ..._.-_ ----------------------------•---- ----- -� --- - - Final Inspection by: - .c� .......................••...........................----------------- -------Date EH 13 22 1-68 Nov. SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M