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FOR 0FFICE USE:.r F APPLICATION FOR SANITATION PERMIT y /o 7--rf �! Permit No. .. ....-_...--- -. ..................................... . (Complete in Triplicate) ........I........... . . . .. Date Issued This Permit Expires 1 Year From Date Issued 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 compliant with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _.1-.�_- •--- -r �- CENSUS TRAGI ............. . Owner's Name . . ...._ ..-•.....................:.-..............._.............................Phone 44 -- - -M....- ---• Address _ S-2 ._.Q.. -_ :..city . �" x.� .�........... .... --.- .._... Phone Contractor's Name . A R..L .�-. �cc.-. i ?.,�,....License # .................. �7.. Installation will serve: Residence X.Apartment House Commercial QTraller Court 0 Motel []Other Number of living units:... Number of bedrooms !:!�: Garbage Grinder -:....._..._ tot Size .�-..••••--••••- --••••-•••-•• ,..........Privat@ Water Supply: Public System and name ___ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat Q Sandy Loom {]. Clay Loam Hardpan Q Adobe Fill Material ............ 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 240 feet,) PACKAGE TREATMENT i SEPTIC TANK I ] Size...:................................._.-------- Liquid Depth .......................... Capacity -------•--------- -- Type _----. Material......-•••------------ No. Compartments ..................... Distance.to nearest,• Well ..Foundation .............. Prop. Line .................. LEACHING LINE { ] No. of Lines --------------- ------ Length of each line....._.-------.............. Total Length ....._..__..........__ ......... 'D' Box -----.-.___ Type Filter Material ......:.............Depth Filter Material ..............................._....._...... ' Distance to nearest: Well ........................ Foundation ----- ........ Property Line .................... SEEPAGE PIT [ ( Depth ---------------_-_ Diameter Number ---------------------------- Rock Filled, Yes ❑ No Q r Water Table Depth ..Rack Size ' Distance to nearest: Well __ ....Foundation ----_-•---.------- Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# 0 ' -- Date ...:.............................•) A Septic Tank (Specify Requirements) .... .... Pt ........ - _7n..................................-................................... Disposal Field (Specify Requ•reme s) .___ =----- -• �sxw�" "r ............... .......................... ............ Pt i ... - required ..----•-•..... -- .• ,mss- .. (Draw existing and 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, l shall not employ any person its such manner as to bec a sable Workman's nsation laws of California." Signed _ .�•2�,.t-�--"-'.R_�f:S�!-�'-------._74 X_...----•- - ..............jlwner BY - �.. '` .... _..._.__ Title -.. . . . . . lif other than owns ) O R DEPART ENT USE C)NLY APPLICATION ACCEPTED BY _----. DATE BUILDING PERMIT ISSUED ------->----------- DATE ........... .. :_.. kADDITIONAL COMMENTS ---•--------_---- ---------------••--•-- ....................... --•-_----------•--- ............... ... .................................. F -• •• .................... --- - - -- -• - -- .-. -- -_ - .---- - -- ---.. ' final Inspection by: . ---- Dat%fl �-. Eli 13 .2h 1-68 Rev. 524 SAN .lOAQ IN LOCAL HEALTH DISTRICT 8/711 3M