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-FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) ,. Permit No. 1. J5 rt ...•..........•.... .......... ................... This Permit Expires f Year From Date issued Date Issued ��S-.2�. Application is hereby made to the San Joaquin Local Health District.for a described. This application is madi.e in compliance with County Ordinance No . 549 and existing Rulesermit to con 1,struct andtalndt Re work herein lations: gu JOB ADDRESS/LOCATION . , ._ ._..._. CENSUS Owner's Name . . . - _..,.M_ „TRACT .......................... Address .......................... Phone ......._....:_-.... ...............3-fid i .•-�- -• ....... .. City' .`21 Contractor's Name ._..._•••-•........ ........... -S S--• ;.....License # _ 3 Phone .............. Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Motel []Other ......41 Number of living units:___--•--•-- Number of bedrooms __.....___..Garbo a Grinder --...._,_._•• . g Lor Size .... ............ Water Supply: Public System and name --------------- . ..................................... � Private [ Character of soil to a depth of 3 feet: Sand Silt❑ C.10y ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ Hardpan ❑ Adobe '❑ Fill Material ...-,k... 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,j PACKAGE TREATMENT [ ] SEPTIC TANK-[ Si. ..I r ] Size.--------•---•--_------•-------------- •--- Liquid Depth Capacity -- -•-- TYpe'...- ---••- ------ Material,...................... No. p Com P rtmeLits Distance to'nearest: Well ,.....----•-• f=oundation ..._ ---......_ P• LEACHING LINE _.___-- Prop. Line ____________________ _ m [ ] No. of Lines ........................ Length-of each line.__.::_____._-.............. Tota l Length 1' 'D' Box ......--.... Type Filter Material _..-_---_-........:__Depth Filter Material ............ . C Distance to nearest: Wel! _,..:.........:..:...... Foundation ........-_---- • •------ Property Line G. SEEPAGE PIT .---d•••-•.........- L ) Depth __-.... Diameter —'�-�- '---- � Number -----•---.-_---- Rock Filled Yes No C3 0 . Water 'fable Depth .........Rock Size _ i. . Distance to nearest: Well ... ........................... ....__.Foundation Prop Lina . 4 . REPAIR/ADDITION(Prev. Sanitation Permit�# 3 ., .............................. Date Septic Tank (Specify Requirements)___ _.. .................. Dis osal Field S(Specify Requirements) � .---•---------•------------------w..... _ _..---- ...._ �P _ y-• f P Y ,. `'Fcitr - ---.. .......---•--------• (Draw ex' tin 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-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 m nner � as to become subject to Workman's Compensation lows of California." Signed _r................................ BY _.-_..-- y Owner _..... - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_....... ... _ ... .. :._. DATE ........ _ .._... = --•-- ... BUILDING PERMIT. ISSUED ---------------•-....... = ADDITIONAL COMMENTS .......:.........••-•''•' .:DATE - ..........:......•-------••--...-_...._...__..... --•••--:... --- •..--__.._.......I.....•--•••.•-••.....•-•-•....._...-----------.---.:..__.- _.. ....._............................................ .. ..... ....... Final Inspection by: ......ate ... . - SAN JOAQUIN LOCAL' HEALTH DISTRICT i E. H.ZRev. 5M 3 .24�-'68 R .,�... .. __ � �. __.�._ - ....,........a. x - - -- -