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FOR OFFICE USE: APPLICATION FOR SANITATIONPERMIT ................... ..................................... �s--. �� IComplete In Triplicate! Permit No. .............•---.... ..................................................r '� 'ylhls Permit Expires Z Year itrom Date Issued Date Issued Application"is hereby made to`tie Sari Joaquin Local Health District for a permit to construct and install the work herein € destribed. This application is mage-in compliance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESS/LOCAT N �-.- . ................ CETRACT Owner's Name .= • s....... ..................................... ...... n ... . . ,. .. + ..... Phone .. .. .......................... Address --..- . ° -......... ......................-............ City . /.. . ................................................ . Contractor's Name ---. �. _-_P.-B_/7! _...---•....... .............License # `✓� � Phone Installation will serve: - '""" `""Residence i � A artment House 0 Commercial ❑Trailer Court ❑ h Motel ❑Other` $ Number of living units:'___...__._.. Number of bedrooms � Garbage Grinder �/O 3� ! .....-- -••-••-- Lot Size t ..... e.�.._......... - Ater Supply: is System m and name ................................................ .......�._......................_................. Character of soli to a de thof private 3 feet: SandL] Silt❑ Ciay o Peat❑ Sandy Loam ❑ Clay t.oam ❑ Hardpan(J Adobe Fill Mater€al ............If yes,type !Plot plan, showing size of lot, location of system in relation to,wells, :buildings, etc. must be planed on reverse side.) I NEW INSTALLATION: (No septic'tank or seepage.p permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC,TANK j 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 x rn E D' Box _.....__.'. Type Filter Material ..--••..............Depth Filter Material ...... Distance to nearest: Well ............ ............Foundation ........................ property, Line ......................... O SEEPAGE PIT [ Depth -------------------- Diameter Number J -------•-••-•••- ............................ Rock Filled Yes ❑ No 0 Q I Water Table Depth ---------------------...........................Rock Size .....------•-•. ................ " C Distance to nearest: Well ........Foundation . Prop: Line REPAIR/ADWTION Priv. Sanitation Permit Date I Septic Tank (Specify Requirements)................... ............................. :.....� :.... ... ..��.. ..:� ".......... - -` Disposal Field !Specify Requirements) .-.--42........�P ��- �__ - ..... ` ------ i ;"` ........... ......... --- --•-- (Draw existing and required addition' on reverse side) i 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, I shall not employ any person In such manner as to become subject to Workman's Compensation :laws of California.,, Signed --- -------- ---- ---- Owner By ..........------------- - _-------__- Title (if 0 er t an owner) t FOR__VEPARJ,MENT LISI«.,ONCY APPLICATION ACCEPTED BY -- ---.t_ ..__.._:..- DATE .11146171 _..-- -•--•-.....--- ----._ .�`_....---.._: BUILDING PERMIT ISSUED ..... -------------- -------------- ---_--------------DATE .................................. ADDITIONAL COMMENTS ---•--------------------- ------------- ,,��••�-- f+r Y.. ... ..... . .._..... : �� -...Date final'�Inspec on by: .___ _--------" ` ER 13 24 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT $/74 3M I '