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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .. t2 � � mp in TrpPermit No........... ...............................•-- a ...._. t "" This Permit Expires y Year From Date Issued bate issued .,�-`,�� Application is hereby made to'the So Joaquin Local Health-gistrictafor� a �, described. This appi'ca#io ' ern - xpermit to:construct and Install the work herein ace wIt l 'unfji'O dinance No: 549 and existing Rules and Regulations: JOB ADDRESSAOCATION _ ..._.CENSUS TRACT Owner's Name .----....... i % --_----•.... .... _ .. Address ..............r....------- .........Phone .�J.._.. .e, ... S city Contractor's Name ............ ... ........-..License #.�5�'3Yj Phone .�.fQ.�a--11`7.4. •_ Installation will serve: #1 Residente�Apartment House[] Commercial'(]Traiier Court � - �Mcatel�]-Other-•--..-�.__.---_•--._-�:,--------•-••--- Number of living units:` .... Number of bedroom-s '"° : G'a «gd Grinder __...._---__ Lot Size Water Supply: ... •��, _ Public System and name ._...-------••---- ,•-•--- - z - _ ---• ------•-------••------•••.............................................. Character of soil to a depth of 3 feet` Sand 0 Silt[] Clay "�' _- - .r. Y C] P eat C3 Sandy Loam 0 Clay Loam 0 _ Hardpan Adobe Fiil Material ..--...__... If yes, type ........................ i r {Plot pian, showing size �f lot, location of system. in relation to wells, buildings, etc, must be placed on reversetside.) NEW INSTALLATION: {No s ptic talnk or seepage pit permitted if public sewer is availablewithin200 feett JN PACKAGE TREATMENT f, SEPTIC TANK-0- 1 ,. t t' Z . ize.__....§T)C_ II__. r ` F Ypg - ...... .r_- ._. �LI uid Depth _ Ca acit a t p Y � dT y Md�teriai:_� �� No., C meats Distance to nearest Well r' ompart ......._.. t .ltiv�0.c:±�_:.. _ Fdatian•,1�.: f'_.-::._ , LEACHING LINE `' _ Prop. Line (� No. of Lines C__._......--_.__... Length of each line _ Q r....... Total Length .../RA___.:..... i• :su�r Type Filfer'lWofe ial R `di -� - .._ .. ..----Depth Filter�llM1dterial�.-___;f-�'- - __=,- _ J 7.............. .._......_... Distance to nearest: Well _.,, -•.-- _..--• Foundation /a-�+-.-_--• pro SEEPAGE PIT "... y _ �. .^A 6r •- Property Line ..,5_.�------__- I Depth .._,,' ----------.. Diameter ....... Number _.--.. ............... Rock Filled Yes No C) Water Table Depth ............................................. .._Rock Size /4... .--- � Distance to nearest: Well ........ - Foundation ...-l ...' +- Prop. Line REPAIR/ADDITION Prev. Sanitation'Permit - { # ----------------- -------------------- Date Disposal Field iS ecif Requirements)Septic Tank (Specify Requirements) 1 --------------------------------------------- -•....... •--- . _ .-- ......................... ............... ............ - (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: "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 ._......._.._. . .._... ' lf of than owner) ---•----- Title ------ 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ................. . BUILDING PERMIT ISSUED ..............................................................• DATE ADDITION ------•. .......... ............................. AL COMMENTS . �' ..: +� ••-- .....__..... ATE ................................ •-- -•• Fina( Inspection by .................. ----------------...................... ....................----••- : ........_. .:..._,Date �. A.. ._.7. __.:. 1 SAN JOAQUIN -LOCAL HEALTH DISTRICT �,E _H.1.3 24 1-'68 Rev. 5M