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FOR OFFICE USE: �_�.±�r.b. '"`.._.: APPLICATION FOR SANITATION PERMIT )Complete In Triplicate) .. Permit No. .................. This'Permit Expires Date Issued ... ...............................••----•----...._....... p res 1 Maar From Date 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: JOB ADDRESSAOCATION �-`- b- P ...... -4- ' CENSUS TRACT Y .............. Owner's Name .................. ... , ..... .. _ .--- `` ..................�._.. - on ,... .. ....... ... . �3I— 3 54 Ph a .. ---....--•-••--- ... .-- Address ............... ._.. - .... City-)... ..........•--....... Contractor's Name ............... : ... License#25Y-S 3_.-- Phone .7 Installation will serve:` Residence j�(A artment House❑ Commercial❑Trailer Court ❑ Motel ❑Others............... + Number of living units:-,---- __ Number`of 6clroomi ..:..Garbage Grinder' S;xe r C? Water Supply. • ..... . .... ............... Public System and name - r ,� Y ,. -_ ......................Private ] Character of soil to a depth of 3 feet: Sand -silt , D -❑ clay ❑ °'Peat Q Sandy Loam fl Clay Loam ❑ Hardpan❑ Adobe 0Fill Material ...... if yes,type (Plot plan, showing size of lot, location of system in relction 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 [ ] SEPTIC TANK f.] Size...................... Liquid Depth ................. •-•-•••-•---.._. ..........�. TYPO ------_------------ Material...... 1----- ---------------- �-- -----•- No. Compartments Distance to nearest: Well ----------_. _-_..-Foundation ...... Prop. Line LEACHING LINE [ ] , No. of Lines ........................ Length of each line........ Total Length 'D' Box ............ Type Filter'Mp#erlal .............Depth .Filter Material Distaste to nearest:`Well ....--------•-- ... Foundation .;...................... Property Line ... SEEPAGE PIT { j Depth .................... Diameter ................ Number .....f_....___ ............ Rock Filled Yes ❑ No � Water Table Depthr Rock size Distance to nearest: Well ............................... . Foundation Prop. Line REPAIR/ADDITION(Prev. Sanitation-0Permit# .................�-- .. ~ -----_- ------ Date ----••-----••...---•-••-•-........ Septic Tank (Specify Requirements) ..............._ --•-------•---•-------------- ................. Disposal Field ISpecify Requirements) ...._ --- , Q--_ _ K -� . ..... ................................... .. 3 -------------------•----- ................ (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, 1 shall not employ any person in such manner as to become sublect to Workman's Compensation laws of California." Signed ---- -- I Owner ----- - --••-----------••-------_--- ------------ BY �.. ---- -- - Jitle.-.._ '.._ of than owned FO EPARTMENT. SE ONLY- APPLICATION NLY- r APPLICATION ACCE TED BY _.11 . _.. -- ---- ._--- ---_••--------- .. DATE _.� ..-�.• .._._,_ BUILDING PERMIT ISSUED ------------------ -- - -•-._ -- ---•- -- ----- ---- DATE .......................... . . .. . ADDITIONAL COMMENTS ------------------ ------------------------- --•-• ------ .........,.--------------------------------- ----------- --------- ---------------------...--------------------- FinalIns ection b - -- �- -•-•-•-----•-�- --- •--....-----�-••-------•................- •...........-•- ..._, p y: .. .-. - tiG................. -------!)ate ..... _. .. � EH 13 21� J.-68 herr. �i ....�-�� --7--/------�- SAN JOAQUIN LOCAL ACTH DISTRICT 8/Ili 3M