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FOR OFFICE USE: //�rf�•�j��' APPLICATION FOR SANITATION PERMIT r� ..............a_ ..._......_....----•- ." . Permit` (Complete in Triplicate) Permit-14e _..1� .... F _ . ...........:......... ... . Bate Issued. .. This Permit Expires 1 Year From Date Issued Application is hereisy made to the San Jooquin local Health District for a permit to construct and Install the work herein f described. This application is made in compliance with County Ord once No. 549 and existing Rules and Regu!otions: JOS ADDRESS/LOCATION ... .�-_1.�....- .... <.. :.......................CE SUS TRACT .......................... h Owner's Name �� --• ............F one ........___...................... Address ._....... .._.. Ciry .................................... -- ------... i � . �� . . Contractor's Name ........ .... .. ..... .. c ... . ...............................License # 1354p.9 Phone 14 Installation will serve: ResidenceXA.partment Houseo Commercial OTraller Court 0 '. Motel []Other ..............__...................... Number of living units:-J___ -- Number of bedrooms J-...:...Garbage Grinder ............ Lot Size ..1... �-----._._._- Water Supply: Public System and name ..............................................••. ............................................................Private O Character of soil to a depth of 3 feet: Sand O Silt O Clay ❑ Peat O Sandy Loom O Clay Loam o -- Hardpan p Adobe❑ fIII 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 200 feet,) PACKAGE TREATMENT [ ] SEPTIC,TANKf } Size................................................ Liquid Depth ........................... F . Capacity -------------------- Type .................. Material...................... No. Compartments ..................... Distance.to nearest. Well ------------------------------------Foundation ...................... Prop. Cine ..................... LEACHING LINE [ ] No. of Lines ----------/.--..------ Length of each line............................ Total Length2j...................... D' Box Type Filter Material ....................Depth Filter Material ..............................I....... ......� Distance to nearest: Well ........................ Foundation ....................-... Property Line ........................ SEEPAGE PIT [ ] DepthJ. ______________ Diameter Number ..._ PPT........... Rock Filled Yes'X fotoCV Water Table depth ----.7�. �•---•-----------------------Rock'Size .-�-- -••----- Distance to nearest: Well ....................................... Foundation .......... Prop. line ..f��..............Q REPAIR/ADDITION(Priv. Sanitation Permit# -------------------------------------------- Date .._..:............................ ) Septic Tank (Specify Requirements] / r Disposal Field (Specify Requirements) --- D /� �.. 4= ............ .. ............................................ -------------------•------------------------------------- ----------•-------------------- --- - - -----... . . .. . -•---• (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,,State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or licen- sed agents signature certifies the following: j "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner kas to become subject to Workman's Compensation laws of California." F Signed ---------_(-- ----- ---- Owner )" BY Title iochan owner) Ol } F *�. ..... DEPARTMEW USE ONLY APPLICATION ACCEPTED BY DATE :,,.,.:. ..�.,V`. . ........... BUILDING PERMIT iSSUI D ------------------•-•-•------- ------- .. __- �.._,....... ...DA7E-..... ... ADDITIONAL COMMENTS .... --•-- • ----------------------------------- - • ••. - -F ... --------------------------------- ........•--- -----------•---------- ...... ........... •-------- -- ------- . ---•----- ---• - } Final inspection by - = ...Date .... ..... .f!4' i if ' EH 13 2L 1-68 Rev. SAN JOAQUIN LOCA I:ALTH DIS ICT � 8/7h 3M