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.:T R Off ICE USE --{ ` APPLICATION FOR SANITATION PERMIT replete in Triplicate) permit No. ......... ............. ............. •...._.---•-......-....... This Permit Expires 1 Year from pate Issued Date Issued described. This application is made in compliance with County Ordinance Application is hereby made to the San Joaquin Local Health District for o permit to construct and install the work herein No. 549 and existing Rules and Regui,ations: JOB ADDRESS/LOCATION � �f........CENSIiS TRACTCY.,6 Owner's Name .. �� ---------- ............................ ..._......-•------------------- City .'Loo_.. Contractor's Name ........rf�J.dZ�i�;;--------------------------------------•---••-._......---..License r# ........... Phone ..---.: ........ _. Installation will serve: Residence❑Apartment House❑ Commercial❑Trailer Court 0 Motel:'Other ,� ? � Number of livin-g-units:-.._------_ Number of bedrooms ---1----.Garbage Grinder o-.... Lot Size ..R_..,.4,G,��,,� Water SupplyPublic SysFem and acme s ............:............••---..._...............Private Character of soil to a depth of 3 feet: SandW Silt ❑ Cla Y ❑ Peat[I Sandy Loam C] Clay Loam 171Hardpan ❑ Adobe❑ Fill Material ............ If yes,typep (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 avoilable'within 200 feet,( PACKAGE TREAT.MEtsIT...[ ] SEPTIC TANK -� •----------------------- ---- Liquid Depth ................... - Capacity y ---•--- TYpe�h� Material..............• No. Compartments .. .e Distance. to nearest: Well _. - - Foundation -� "'.. ---- �7 ......_. Prop. Line .�7' ............_.. LEACHING EINE , [ l No. of Lines ..../........ Length of each line.-_.745................. Total Length f. 'D' Box .f Type Filter Material�`.:� /J Depth .Filter Material .."/J ........ Distance to nearest: Well --7f"..._,-- Foundation -./�-f'_.._••,- Property Line ..,�' 7� J. ../.......... i _ •l Q I. th meter Nu er R Filled Yes No ------•----•-- \ ❑ Wate Table Depth .._ k Size . -•------•-..--------- Distance to nearest: Well ----------------- ------ foundation .------•--••-•--.... Prop. line ................ REPAIR/ADDITION(Prov. Sanitation Permit# .......................... . . ... Date --- ------------- •--- 1 . Septic Tank (Specify Requirementsl ...... .. Disposal Field (Specify Requirementsl .-----_--_ 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 Local Health:tllstdct. Home owner or liven- 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 su ect to Work n's ompensation laws of California." Signed X . - ..... Owner BY ---- -------- title •----•---- --••• fi (!f other than owner) . -----.- - F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- BUILDING PERMIT ISSUED -------------------- - - • DATE :, -•�7 --- ------ ---•--------- ------- ----••.....- -------- •• DATE ADDITIONAL COMMENTS ----------------- . , ' .....::. .�... •------ ---------------- ...................... .............-............ ... ...... --- Final Inspection by: -. Ex13 2h 1-68 -- --•---------------••-------•------------•----- -------- ........._...-------Dame .....' �/--/. • SAN JOAQU#N LOCAL HEALTH DISTRICT $/7h 3m