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FOR OFFICE USE: ..- APPUCATION FOR SANITATION PERMIT n (Com left' Triplicate) Permit No. ..................... .......•......... p � iP ) .................`'— This PorrWt`Expire:A'YearFrom Datelssued Dote Issued Application is hereby made to the San Joaquin tocol Health District for a permit to construct and Install the work herein described. This application is made in compliance with County Ordinance No: 5:49 and existing Rules and Regulations: 3 JOB ADDRESS/LOCATIO ! �� CENSUS i ` •• ........................ . E DO r Q_. ....c --� 1/Pr------ ....._.. :. .................. S TRACT Owner's Name Phone Address ...... ....... --- - ............... City Contractor's Name ._ _••_-_----- "' License # ......... ......... .... Phone ... Installation will serve: Residence&Apartment Houseo Commercial QTrailer Court ❑ Motel ...----- i Q Other........._�..---• ..:......:........ Number of living units-_1.... Nurnber of bedroo s Garbage Grinder ........... Lot Size Water Supply: Public System and name k...........................Private Character of sail to a depth of 3feet: Sand 0 Silt❑ '`Clay 0,t-'feat❑ Sandy Loom N' Clay Loam ❑ Hardpan Q Adobe o Fill Material ............ If yes,type (Plot plan, showing size of lot, tact(on of system In relation.toiwefls, 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,) A PACKAGE TREATMENT PJSEPTIC TANK ��wtde ¢ F�`,( �� p ] Size_...._ ----- u Ae th .......................... Capacity -.._G-i10_ � Type _-•-• Material.i7. Wr71J�:SSNo. Com artments Z........... I Distance to nearest- Well ...�_._31....�..Foundation ... ... Prop. Line .. . off.... LEACHING LINE ! N6.-of Lines ..__- ._. ---.--- Length of each' line-----_ ¢SZgTotal Length 'D'1. Box "� • (/. Type Filter Material -_•--.Depth .Filter Material �g /---. 4 f:r / t �..._ Distance to nearest: Well ../ 0 e. ._--. Foundation _ _ . _.t __._..._ Property Line ._X _ ..... SEEPAGE PIT [ ) Depth -------'____. ....... Diameter _-------._ - ��. _ __. Number ............................ Rock Fitted Yes Q No Q Water Table Depth --- ................ --------••--. QRt ocze -- . Distance to nearest: Well ...............................I........Foundation ..................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation(Permit# --------------.------------_- _---_---- Date ._... ............................. Septic Tank ISpecify Requirements)-,........................................... ---------------•--------....------••--.....------••---- Disposal Field (Specify Requirements) ---•............................................• ---•-•-•-...... ----•---- It ----_._. - - . ....................•----....----•-----•-----••---.......---.....__._..._.__......__._._.. . ' 0 ` (Draw existing and required addition on reverse side) i I hereby certify that I have`preparL this application and that the work will be done 'in accordance with San Joaquin County Ordinances, State Laws, and Rul®s and Regulations of the San Joaquin Local Health.Dlstricf. Home owner or licen. sed agents signature certifies the following: "! 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 become subject to Workman*%'Compen 'on laws of California." v i Si ned _. By ..... ------------------------- ----------- -------------- •--------------- Title = •----- *P �. .,.(I .other -thawownerl FOR`DEPARTMENT USE GINLY APPLICATION ACCEPTED BY ......... - BUILDING PERMIT ISSUED ........------.'-_----_-_--.---------•---•------.--.-_-.-_- .......... ........---•--•---- '....... --------- DATE .. U -- ..__ :DATE -T ... . �AD fTIONAL COMMENTS --.......-� .__.'- � B s e.� 8✓-- WJ S �c - - Final inspection by: ----------- - .............................Date _.f�..... EH 13 2h 1-68 aev. 5M � SAN JOAQU1 LOCAL HEALTH DISTRICT 8/7!i 3M