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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Trlplicatel . .........��3 Permit No 7� A1........................••-............ _... This Permit Expires t Year from Dot o Issued bate Issues! Application is hereby made to the San Joaquin Local Health District for a permit to construct and Instalf the work herein described. This application is made in-compliance with County Ordinance No. 549 and existing Rules and Regulations, ! JOS ADDRESS/LOCATION ....... t:._1� G� � .. C _ _ ENSUS TRACT Owner's--Name Alone Address ....-.... '`> �.. +�- rr� 5-..-.......- ....... . .�/. .......City r 3 .�.. Contractor's NomeLicense i Instgliation will serve: Residence Apartment Nauze`0 Commercial QTrailer Court Q Motel Q Other ........... - Number of riving units:-.. o bedrooms�?' .° r^ .,.... ` ? � Number f_, Garbage Grinder 'Lot Size .. ........................ Water Supply: Public System and Haase z :y . .... ...... .. ._"" ,r: ...... l Character of soli - _ --� 1 � .. .............. . . vale to a depth of 3 feet.. Sand[ . Silt Q Clay G-.Peat Q Sandy loam Q Clay loam ! Hardpan0 -7 'Adobe 0 Fill m6tertat4...:*. ...If yes,typee......:.. ............. (Piot Plan, showing-size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse aide.) NEW INSTALLATIONS (No septic tank or seepage Olt,permitted if public sewer is available within 20 0 feet,) PACKAGE TREATMENT } SEPTIC TANK ] SizeLiquid Depth Capacity .............. ..... Type .................... Material... ......- ....... No. Compartments ....................... Distaste. to nearest: Well ..... ....... . . ......... .Foundation ...................... Prop. Line ...................... LEACHING LINE 1 No. of Lines ....:............ ._ length of,each lite. ... .. Total . .. _... - ata Length . . 'D' Sox . . .....:. Type Filter Material ............... ....Depth filter Material ............................. ....... Distance to neorestc Well Foundation ................... ..................,..... Property Line ........................ SEEP.._,_AG... E'PIT } Depth .............. QiometerNumber ............................... Rock Felted Yea Q Na Q Water Table Depth ........................•......-................Rock Size .. ......._. .......... Distance to nearest: Well ......... ........ :...f=oundation ..................... Prop. Une ...................... REQ PAIR/ADDiTION}Prey. Sanitation Permit Septic.Tank (Specify Rectuirements} _......- i...... Date .................. .. , .. .} 1. ............................. ......... . .......... 7Dfsposal Field (Specify Requirements} -------_- _._ - ,� ......._ .---------- ... --------- .... ...--................ .................... q------------------ _.._.................•--............. ................. .......... ' } (Draw existingandre cared addition on reverse sidel— l I hereby cert€fjr that I have prepared this application and that the work will be done in accordance with Sats .li mqu n County Ordinances, State Laws, and Rules and Regulations of the.San Joaquln Local Health-District. Hance owner or Ilton- + sed agents signature certifies the following:. I certify that in the perfor ante of the work for whii:h thiserntit ix issued, l shall not employ n p_ p oy any person In such manner as to become sub..ct to orkm 's pensation laws'of California_." Signed -.-..r..0 '. --_.. ------ ._ Owner BY ... --- -------------• ----------------- ------ Title ........ ... ------- j If other than owner) F DEPART NT USE ONLY APPLICATION ACCiPTED BY 7e .... .. 4 -----..,DATE .... : -.,. . . BUILDING PERMIT ISSUED DATE ....... f ------ ADDITIONAL COMMENTS ....---- - - _.:..........:................ ................. ..............•- ---------------- ------- ' ........_... ......................................................................................... -------- ----•- . Final Inspection b EH 13 22t 1-68 itcv. 5'M SAN JOAQUI LOCAL HEALTH DISTRICT 8/7h 3M