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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ 1.z.'�c?.......... .................. d I Date 1Compt*b in Tr; Permit No 7S• 5-- 3 ........... p . . ......... This Permit Exptees 1 Year freta Domissaied ........... 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 549 and existing Rules and Regulatianu JOB ADDRESS/LOCATION ......f._ /S�j /5..... 5 L!5 �t1°._... .........................C TRACT ......... Owner's Name / Lr. .� _..._!n?C1-�rl 1�................................................................ .........Phone (( // Address -.� Y7- - .. SYL�'� ......... Contractor's Name _.. ._ l Cmc., /1 ....... ........ .......... ..Liicense ._ ..........•. Phone Installation will serve: Residence U Apartment House fl Commercial❑Tralior Court Q Motel❑Other............................................ Number of living units.-..-/------ Number of bedrooms-3.......Garbage Grinder ............ Lot$ize ............................................ Water Supply: Public System and name .......................................................-..-...................................................Priv ft Character of soil to a depth of 3 foot: Sand Pt Silt Q Clay Q Peat 0 Sandy Loam Q Cloy loam Q O'(� Hardpan❑ Adobe 0 Fill Material ............if yes,type........................... (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size...................... ....................... Liquid Depth .... .................... Capacity --------------/ame ype ............----- terial. ......_........... No. Compartment: ............. Distance to neareell ................. ............... .Foundation...................... Prop. Line -------............... LEACHING LINE [ j No. of Lines ....... ........ Long of each no............................. Total Length ............................ 'D' Box ............ Tilter Mat a) .......... .........Depth Filter Material ............................................ Distance to nearesll ....... ............... oundation ........................ Property line ........................ SEEPAGE FIT [ ) Depth ------------------ mo - Number ............................ Rock Filled Yes ❑ No Q Water Table Dept .. .................. ...................Rock Size ................................ Distance to nearest ............... ._..................Foundation .................._. Prop. Line ...................... REPAIR/ADDITION(Preva Sanitation Permit .............. ........................ Date ............._....................Septic Tank(Specify Requirements) . --- ..._.._.._.._ .... ...... - ............ ......................................................... Disposal Fie d (Specify Requirements) . .... v� ...._.._._. /._ .---.....��.. ............................ .................. . ........I....... ----------- -------------- --------------- -----------------------•-...........................-............................................................................................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that dw werk will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sen Joaquin Local Heald District. Hem* * mor or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is Issued, I shall not employ anyperson in such manneras to become subject to Wa an's Compensa n laws of California." Signed.. -. ... . ----•-• ......................... Owner By •-------------__- . title _.... ............................................. (if other than owner) _ FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ....--•.- DATE .��'.' ..::.2.1>....._. BUILDING PERMIT ISSUED ....................DATE ------- .-- ......•....---.............. ADDITIONAL COMMENTS .._ ...._..... _..._..... . -----. ..........................--•...................•---------... .........__.....I.........---.. ------- Final Inspection by: __13 21, 1-68 Rev. i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M