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FOR oFFlcl USE: APPLICATION FOR, SANITATION PERMIT yG 3 -�- ------ -J- �-r--- -- -- � j� Permit No. �--�-r-5-�f--- -d ---" - �/ (Compiete.in Triplicate) -�2•-�-----=--� -� �-t3--�---�---- � l� Date Issued This Permit Expires 1 1Year From Date Issued Application is hereby made to the San Joaquin Loca Health District for ❑ permit to construct and install the work herein described. This application is made in compliance with Count Ordinance No. 549 and existing Rules and Regulations: ADDRESS/LOCATION � _ / ..5�� ENSUS T ACT ----------------- -------- JOB tel/ p .- Owner's Na " -Phone ------------------------------------ Address ------ -------------- -- -- ----- ------------- City --- ------------------•-------------•--------- Contractor's Nam «^ ---------- = € License /. .3 - Phone - Installation will serve:- -Residence partment-Hou se❑ Commercial ❑Trailer Court i❑ Motel Q Other ------ ----- ------------------ ---------- €� I Number of living units:________ Number of bedr _ 'Garbage Grinde _____ Lot Size -21 ------------------- Water Supply: Public System and name------------ - � JPO � -'----------------------------------Private ❑ r Character,of soil to a depth of 3 feet: Sand'❑ Silt❑ - Clay- —Peat ❑ Sandy Loam❑ Clay Lo❑m:❑ y it - Hardpan ❑ Adobe l� fill aterial__ 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 permit#ed if public sewer is available within 2d0 feet;} PACKAGE TREATMENT •[ ] SEPTIC TANKY, Size___f _________ Liquid Depth , ---,--- {A Capacity Type ___f�'�t'x� ial __ - -C No. Compartments --------------•- ---- Distance to nearest: Well - Length��of ach IineFour�dation �--------------- Prop. Line " / LEACHING LINE [ No, of Lines ---a--_-.--- g 1, - �- F- ------ Total Leny�h D' Box . Type Filter Material.:_ Depth Filter.,Material ------------------ 4F Distance to nearest: Well ___-� __`.a______ Foundation ! - --- Property Line ------------ SEEPAGE PIT [,��Depth _&4S 1__.___ Diameter `---- Number ------ ------------- Rock Filled Yes ( ��❑ Water Table Depth 4-- -----------------...Rock Size._/Z.--_'_2----------- J� Distance to nearest: Well ------ ---------------------Foundation ---"-- ------ Prop. Line 1_6-------- 8.-------------_--- Date ------------------------------•---I REPAIR/ADDITION(Prev. Sanitation Permit�5� ___________"_____-___ Septic Tank (Specify Requirements) ------------------- - ----------------•-------------------------- - ----------------------- Disposal Field (Specify Requirements) -------------- r ----------------- -------------------- .. .. -------------- ---------------------------- ------------------------------------------- --------------------------------------- -- -------------------------------------------- - - ---------------- -------------------------- ----------------------------------------------------- (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 sof 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-subject to Workman's Compensation laws of California." ii Signed ---- -- --------------------------- - ------------------------------------------------ -a--------- Owner Title _/lrL�ZG��.rrf ----- - BY +. (If other tha o ner i r r.- 0 FOR DEPARTMENT USE ONLY oo,APPLICATION ACCEPTED BY - - - ------- ----- -- ------------ --------t------------------------------------------ DATE _.. ---- �1 7 _ BUILDING PERMIT ISSUED --- ----------------------------------- ,1 -------DATE ------------------------------------------- ADDITIONAL COMMENTS ____- i' __ ------------------ ------ ----- ----------------------------- - - - ---- - -- -------------------------- --------- - -- ---------- - -- --- -----------<------------------------------------ ---------------------- ----- ------------------- Finai Inspection by: i; -------------------- Date _ _— 11 TAN JOAQUIN_ LOCAL HEALTH DISTRICT E. H. 9- 1 '68 ev,_5M