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FOR OFFICE USE- ..........._ APPLICATION. ICOR SANITATION PERMIT ......:.............. .. .... Kornplete.In Triplicate) Permit No. ... Thls Permit Expires I Year from Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulationss JOB ADDRESS/LOC ION ._ I ........ . C :._.... �•.:... _ ..... --- .Owner's Name _.. S TRACT Address ..:o�?. '(o -..� _.. ..,'..........• t. Phone .. _. city' -- - Contractor's Name .._..:.. ..!!tense, • •-�------•-•--••---=-•--•.:---....-•-----•-•-•--------=-----• ................. Phone - ...._... . Installation will serve: Residence Q Apartment House(] Commercial OTrallw Court Motel ❑Other I ---------------•-----•---•-- Number of living units:............ Number.of bedrooms ............Garbage Grinder ............ Lot Size Water Supply: Public System and name Private 0. ] Character of soil to a depth of 3 feet: Sand El Silt b Cfay 0 Peat❑ Sandy Loam Clay Loam ❑ Hardpan d Adobe 0 Fill M6terlal ............ If yea,type............... ............ I (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed an reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer Is available within 200 feet,I s PACKAGE TREATMENT .[ ) SEPTIC TAMC r : ...................................... Liquid Depth ....... - .- Ca aci Tye ......__... material No. Compartments tY ...... . ..... ......:...... .,. �. ©!stance to nearest: Well . .......... ............:.Foundation ...,�©_.......... Prop. Line ....................... LEACHING LINE "j j No:sof Lines .__ . Length of 'each line..... --••---------------- Total Length ...L.V..o.............. 'D' BoxY:6XRType Fitt e Mater#al �� /G h Fitter ateria) .-I-q..•- Distance to nearest: Well -•------- --------- f=oundation s ......... Property Line SEEPAGE PIT [ ] Depth .................... Diameter ................. Number .-------------•-•-.......... flock Filled Yes ,[J No 0 Water Table Depth -•--------•-•-----------------------------------Rock Size ........... ...... •-•-•---- A s Distance to nearest: Well ......•--------------_--_____----------Foundation .---...... ......... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................ Date ........... ........................ ) ! Septic Tank (Specify Requirements) ............ Disposal Field (Specify Requirements) -----------------••--------•- : --- ----- _ _ (Draw existing and required addition on reverse side) I :hereby certify that I have prepared this application and that the work will be dons in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hoallh",Distrlct. Nome owner or Iicen- 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 bec me subject tg Wor an's Com ensation laws of California." Signed --------------• Owner BY -------- --- - '------------------------------ - - -- itle --------------- ----------------------- (if other than owner) FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY _----- - `_-- - •- .................._DATE......_. .. .. 4 .-.T,. _____-•• BUILDING PERMIT ISSUED .........:.. ....... ; ...•-�.... ........ .................. .... .......... .•--- -•'---.._.....©ATE ------- --... .. ADDITIONAL GUNMEN S - .,� .. . .... :..__..Gt/t.�C-.._ ....--...... " r .._.-Q_.....{1'Y.�--t�s�.... .. _..._ Final Inspection by: .............._.. -_ Hate . � » 13 24 1-68 ltev. SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/7h b3M