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R OFFICE USE ......... ......... APPLICATION FOR SANITATION PERMIT ". Permit No (Complete In Triplicate) .................I This Permit Expires 1 YeFrom#late Issued Date Issued ar ....... ....... 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 No. 549 and existing Rules and-Regulations JOB ADDRESS/LOCATION .._. ..... 1. a ////......... r.-.. .. . .. .........CENSUS TRACT .......................... Owner's NameY-.. -..................................... ....................Phone .................................... Address ........� _..1........ .r.. `."/o:-............................. City. ' , `"-..,...................................... Contractor's Name _. d �,-�a� � ..�_.� f {Sl..,,dco ....license Installation will serve: Residence Apartment House fl Commercial OTrailer Court 0 Motel❑Other............................................ QJ* Number of living units:.....42-.. Number of bedroom -� .Garbage Grinder . -�''.. Lot Size ..,� 67:..X. . ...... Water Supply: Public System and ®� ' _ ,.�--_...................-. ... y name ..---�- - -- -'--C.,.�......(,,s..L•�-L�[!�'. .- .. .Private(] _ _ a Character of;soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat Q Sandy Loam 0 Clay Loam 0 Hardpan[] Adobe 0 Fill Mcterial ............ If yes,type.............. ........... (Plot plan, showing size of lot, location of system in relation to welts, 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,) PACKAGE TREATMENT SEPTIC TANK .................................................... .... ( r � rs�jyz .. _ •....... _. �' _.::.-•-•----•- ..:.......... Liquid- Depth ........................... Capacity ----- ......... Type .................... Material---------- •---------- No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop. Line ...................... LEACHING LINE X No. of Lines ......A............ Length of each fine......lee ... Total length ........ iJ 'D' Box ............ Type Filter Material ...........Depth Filter Material Distance to nearest: Well .O':Lsr Foundation .le............... Property Line .-5..... ..... � SEEPAGE PIT ( I' Depth .................... Diameter ............ .. Number ............................ Rock Filled Yes-[1- No 0 WaterTable Depth ................................................Rock Size ................................ _ Distance to nearest: Well ........................................Foundation .................... Prop. Line....................... REPAIR/ADDITION(Prev. SanitationPermit# ............................................ Date ................................ 9 Septic Tank (Specify Requirements) ........... .............. .......... ........................................---... .....4—.1............................ Disposal Field (Specify Requirements) •-•"-•".-"....•......"-"-"---.....--".... ..............•--"-""...............-"-"----•-""-""-----...........................•.......,t .�-._. 0 ...................................................... ............................................-......-...........--"-...................................................................... (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, Sta» Laws, and Rules and Regulations if the San Joaquin Local Health District. None owner or Ueen- 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." Signed ... . Owner By .._. L -�...._ . . ci.............................. (if other than owner DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ... . .... ... . ........ ....... ... ... ------------------------ DATE � ---------_ BUILDING PERMIT ISSUED ..... ... 3 -_DATE .........................)�-----.-------- ADDITIONAL COMMENTS ................ ....... - - - -----"------------------......................................................................... ..............._.................. ..................•-•----- .._... ....................••---.... Final Inspection by: ...-- ---- -- - - . ..----------------------------------------------- .----------- --- -...------•--•Hate ...._.];.:.5.........�,F,.l..-- .. ...-- EH 13 2!t 1-+68 �!! SA JOAQUIN LOCAL HEALTH DISTRICT 8/7h