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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT {Complete in Triplicate) Permit No. ................... ....... .. ..... ......... . This Permit Expires f Year From Dab Issued Date Issued ................... Application is hereby made to the San Joaquin Local Health District for a permit to construct r�Iid:Install the -work herein Y described. This application is made in compliance with County Ordinance No. 549 and existWo ROIit nd Regulations: JOB ADDRESS/LO ATION ..,10.._ I(� • P/. 5.. .tf...�� 1� /.3, JSUS TRACT ' ........... Owner's Name .... ..... A _.. �. ----/Q - 5................. Phone • Address 1Q.0� 14 _ .L.ES tiii/ City :....... ......... .......... ......-...............J_.._ .. .. c......._.._ Contractor's Name 2 �.4 - •-•- -.._ �tJEi+ ;-. --------------License # .4-.-"93 ./7 __ Phone . Installation will serve: Residence�(Apartment House] Commercial []Trailer Court ] Motel ❑Other .............. Number of living units:-.-/ Number of bedrooms ` -------- _._...Garbage Grinder,eSlC?..... Lot Size .. Water Supply: Public System and name .................... ...........Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay 0 Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan❑ Adobe 0 Fill Material ............ 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 [ ] SEPTIC TANK{ } Size._.. }�.�...................... Liquid Depth ..�'..:................. Capacity � c� •-__-- Type __�f6S Material C_�4,�'�o.`impartments _._ ..� . Distance to nearest: Wel! T ----�......................Foundation ..�1.',�7.............. Prop. Line ......... NG tM [ } Noof Lie ._-Z....... --------. LEACHING . ns. Length of etch line- JC. _ Tota! Length ...._.V.7 ...... 'D' Box .._�r,�1_'Type Filter Material Ae Z_ _.Depth Filter Material ...X�f......... r---........ Distance to nearest: Well --- -Q-....------- Foundation --- -----------• Property Line ..,5.............. SEEPAGE PIT [ ] Depth ------•............. Diameter ................ Number ------------ ............... Rock Filled Yes ❑ No (] Water Table Depth ...................... -------•--"..............Rock Size ................................ Distance to nearest: Well ..........................•.............Foundation --- ................ Prop. Line ............... REPAIR/ADDITION(Prey. 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 done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hsalth:Distdct. Homs owner or licew 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 beta subjeq_ _A1ZP1 ct to Workman' Compensation laws of California." Signed .__-- .. . .` Owner By -----------------•---•------- Title --------------------- (If -- other t on o ner) FOR DEPARTMENT USE LY APPLICATION ACCEPTED BY ---------------------- ----•- 1�J4.. DATE ....�-.. .I'Z7 ._. ---------- ---.----• --- --- • ................ BUILDING PERMIT ISSUED ---------------------- • ---------- _-DATE . --------...._..-•---....._...---- ADDi710NAL COMMENTS ----------•------------- ..................... ----------------------------------------------------------------------••-..--------------.------- Final Inspection b ---.....- • --• ��.................................................. p y. -•----••----••-- ' �--------Date ...r� �.- EH 13 21� 1-68 • SAN JOAQUIN LOCAL HEALTH RICT 8/7h 3M 1