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FOR OFFICE USE: ..............I..................... _.._....... APPLICATION SANITATION PERMIT u 7 L lCompMte M Triplicate) 1�`" Permit No V Date issued .......... ............................................. This Permit Expires I 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 compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCA N ......V_.QQ6.2.✓ 3...... . ........... CENSUS TRACT .......................... Owner's Na .....%4...... Address ... L..........-------------------------------------------------............city ... ..................................... os3-tz---J lem !W Jam. -- ... # .�0. 4�7' Phone Contractor's Name _ . .� Installation will serve: Residence jh Apartment House 0 Commercial OTrailer Court 0 Motet Other r Number of living units:.../.... Number of bedrooms .,,.....Garbage Grinder/�36.5. Lot Size -_•- : .... Water Supply: Public System and name .......................................................... ..Private Character of soil to a depth of 3 feet: Sand Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam 0 Hardpan 0 Adobe 0 Fill Material ............ If yet,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ I Size--- X:V............................ Liquid Depth .......................... Capacity .................... Type .................... Material--------- ........ --• No. Compartments .....................IE� Distance to nearest: Well ....................................Foundation ...................... Prop. Line .....................,..,) LEACHING LINE [ l No. of Lines ........................ Length of each line............................. Total Length ............................\P 'D' Bax ............ Type Filter Material ....................Depth Filter Material ...-........................................ up Distance to nearest: Well Foundation ........................ Property Line ........................y SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes 0 No 0 Water Table Depth --•.... ..............................Rock Size Distance to nearest: Well .......................................Foundation .................... Prop. Lino ........... ........?" REPAIVADDITION(Prev. Sanitation Permit Date ) '1 Septic Tank (Specify Requirements) -------•••-•................ ..-.....---..............._.. ............................,.. 0 Di sat Field (S Pacify Requirements) --•-----.Q ...... - ....... c� ........ ... .�' ---... .......!-........ ....................... ...... ....................................... -------•-- ------------------------------•-•-------•-•---...._..--••--------------------------------•-•---......---•------..-•----•--------------•--•-•------• .......................................... (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 tloalth District. Homo owner or lieow sed agents signature certifies the fallowing: "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 beco subject to or man's Copensation laws of California." Signed -------------- - ...----•-m•---- ----.... .....---- •--..._..._._.._Owner BY ---•----------•.........................................._....--•-._... .................. title .. . ..... ........ (If other than owner) EFAR ENT USE ONLY APPLICATION ACCEPTED BY _ .. ... ..._.. -------------------------- PATE . .� ,T--_------- BUILDING PERMIT ISSUED ......................... .. .: ._.......DATE - _--_-- ...... . ADDITIONALCOMMENTS ----_-------- ........ ................................................ ................................ -----------......................................... .................. .... ..X- 5M .... ._....--.... ......- -- ... .. Final Inspection by: ... . ---- -------- -- ................................ - .......Date ... ._ .� .......:. ESI 13 2h 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h .3M