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"FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT d Perm€t No. {Complete in Triplicate) • �• ....... ......_.. ----- This Permit Expires f Year from Date Issued bate Issued ...(/,... .............. Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein i 'described. This application is made in compliance with County Ordinance No. 5,49 and existing Rules and Regulations: . e JOB ADDRESS/LOCATION 307 /- ........ -- __ , _ "u�+�`�!t CENSUS TRAGI ......................... Owner's Name _.- ---- � _ ..Phone Address .._.._....._ �rxlP.�..-. ...... ...............•---•---..._..........-.........----•-•.....--••-..._•---•--- ---- ---------------------•-•----- City ' Contractor's Name ---.-:_ -•-• --..._. License _ Phone .............................: Installation will serve: Residence j;"ent House j) Commercial OTraller Court 0 Motel❑Other Number of living units:_!------- Number of bedrooms _.......Garbage Grinder __..__.. ... Lot Size .............................. Water Supply: Public System and name .Private ❑� Character of soil to a depth of 3.feet: Sand j] Silt❑ Gay ❑ Peat Q Sandy Loom 0 Clay Loam ❑ Hardpan p Adobe❑ Fill Material ............ If yes,type............... ............ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: .-IN* septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f 7 SEPTIC TANK; Size............................................... Liquid Depth ...................-...... Capacity `.....--___ •---__. Material....................... No. Compartments Distance.to nearest: Well ------------•.......................Founda#ion ...................... Prop. Line .....................-d LEACHING LINE O No. of Lines ........______________ Length of each line:............................ Total Length D' Box Type .Filter Material ....................Depth .Filter Mateildl ........... ............................... �1. Di stance-to-nearest: Well-.. ......:......: Foundation<-- v".-.- ....... Property Line ......................... i SEEPAGE PIT [ ) 'Depth t--- -------------- Diameter, ._:.:-.__". Numb re .............. Rock Filled Yes ❑ No �];": Water Table Depth .-------•---•-- = Rock Size ..... S �V 'Distance to nearest:,Well.----.-•-::"............................Foundation .................... Prop. Line .................... ' REPAIR/ADDITION(Prev. ganitatioi►'hermit�• •-. - -_-��_�--.-----Date�-:---.�... .............. ......... .�-..... � �{ �..) Septic Tank (Specify Re uirements ,,-----Q ......... Disposes! Field (Specify Requiremen ) --_--- �................ .. . ...........-- ---•• l --------------------- �..� - ; , - ------------------------..................•........-__-.-_:...................._................................... . s {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,ond-.Regulations of the, San Joaquin Local Health,District. Home owner or licen- sed agents signature certifies the following: �"` ! "I certify the in the perFormance of the work'for which this permit is issued, 1 shall not employ any person In such manner as to bo subject to Work an'sC rnpensati laws of California." --- --------------••--- Owner F •- -- ,..` Signed -�--< ..- -C�_I?_c�_----•'..R.�.?��y--! t By ------ = __ -------- Title ---- ---------------------- ------ -----------------------------•-- {If other than owner) ...� �.. - - R D RTMI:NT USE ONLY APPLICATION ACCEPTED BY ...-----BUILDING PERMITISSUED -.....-, = .....................-------------------------------------.-DATE ..........................-.....----------. ADDITIONAL COMMENTS ........................................................ :. I ------------------ --------------------•--- -------------____------------.----------------•------------••-•-----------•------------------- -------- ...................... ............... ----------------- -------:---------------------• -- -----------•----_------ ------------------------------- ---------------------- ........................... ........................ E ------------------------- .............. r = Date ....--�Final Inspection by: .� Y... .._ lel 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M