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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................. .. Permit No. ...2 lComplete In Triplicate) ....:............ )his Permit Expires 1 Year From Date Issued Date issued ._3.--S...�6 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. 549 and existing Rules and Regulations: .J08 ADDRESS/LOCATION ....14-2.46.-.....�. ..�C��ar�f�fe-�-.._..J . ../�. ,/.CENSUS TRACT .......................... Owner's Name ........... 1 ......---•-----------•------ ----------...... .. . ,/� j�'. ... . ............Phone ...............,.... ..... .--- Address . . ....�� ccis�t v -- .. City _cJ. G. r' . . - --�:X........--- Contractor's Name .-_ 1..� � �,�1. r._ � .........License ,# , _,S�a��/� . Phone Installation will serve: Residence WApartment House 0 Commercial{]Trailer Court 0 F Motel ❑Other ............................................ Number of living units:---/_....... Number of bed ms ---2. Garbage Grinder ............ Lot Size a�—t ..X/.�,�. ........... Water Supply: Public System and name .-----•--� ------ J- T -- • --•--�----- ----..._..........................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt Q Gay Q Peat❑ Sandy Loom ❑ Clay loam Q Hardpan ❑ Adobe U4,146M6terial ............ 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 j ] SEPTIC TANK f Size................................................ Liquid Depth .......................... t.5 _ Capacity ----•------------- Type -------------------- Material...................... No. Compartments •-----. .............. Distance to nearest: Well ....................................Foundation ...................... Preop. Line --._........... ...... LEACHING LINE [ ] No. of Lines ... --------------- Length of each line............................. Total Length ............................CA D' Box ------------ Type Filter Material _...................Depth Filter Material ........................... ................ Distance to nearest: Well .........--.......... Foundation ........................ Property Line ........................ SEEPAGE PIT [ ) Depth ....c .___ biameter .33...... Number ........�................ Rock Filled Yes &---go (:)!P/l�J Water Table Depth --•----------6 ..`... .........Rock Size -...-2�U.er_!_. f ' Distance to nearest: Well -__-- -- -. -..........Foundation —/o......... Prop. Line --_.. ........ ..6 REPAIR/ADDITION(Prev. Sanitation Permit# ......----------------------------------- Date ..................................I A Septic Tank (Specify Requirementsl .-... ................................... ...._.------. ----•=---;--..... .......... ----....,..- ---...... Disposal Field (Specify Requirements) — " �, rte. ......... � ... . .. � -- -------------------- --------.-•------------------------------ ..................... (Draw existing and required addition on reverse side) I hereby certify that 1 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. Hoene owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner i as to become ect to Wofkman's Com ensation laws of California." Signed ------- •--- ----------- Owner By --------------- ------- .�-rC c.. - ••-------- ---------------------------- Title ...... (if of e-r than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------•-----•----•-------------------------- ............ DATE .__. .. _.. .- ... BUILDING PERMIT ISSUED _----------._ ./�,�... ----•-•-•-•-------------••--------------------•------•- •-------------------------------.DATE ........--................................. ADDITIONAL COMMENTS ---- ------------------ .... - ----Ql ------ --------------- -- ------------- --•--------- --------•-------•-- -----••--------------------•----•........... ------........------------. ---------- ---------------• ------------------- -------------------------------------------- • .. . Final Inspection by: .. _. -------------------------- -------------------------------------- ..............Date .... ............ EH 13 24 1-68 ltev 5m SAN JOAQUIN LOCAL HEALTH DISTRICT �3