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FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: -��4.6z ............................ ......... +""-•-- . • This Permit Exp 1 Year From Date Issued Data Issued ..1/:/173 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 ADDRESS/LOCATION S3 ...._.-... Cir..............................CENSUS TRACT _ Owner's Nome .........--- ........ :.... . ..•-- ... .. ........I....... ..... ... ... .......... ................:............ .. ....Phone.. 6 "16,�?z. Address _ .....'..... ...... .......,. _....... City Contractor's Name .............. .. License ,# - ._..... `�,..�.. . 3... Phone V66.... Ez .7.... Installation will serve: Residence Apartment House 0 Commercial QTrafler Court C] Number of living units:_.... Motel ❑Other ._........................................ r ._... Number of bedrooms --Garbage Grinder .._..... Lot Size ...2Q-.. ,t Y Water Supply: Public System and name — - - .. ; - - '-""`•r---....--•---...Private p Character of soil to a depth of 3 feet; Sand D Silt❑ clay [] („Peat[j Sandy Loom 0 Clay loam 0Hardpan l] Adobe Fill Material ............. If yes, type............................ (Plot .pian, showing size of lot, location of. system in�relati to wells, buildings, a#c: 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 j ] yJ , SEPTIC TANK ] Size............. .............................. ... Li4uid Depth•__...................... Capacity Materia}....... Type ---••--.......... .... No. Compartments `.. .............. Distance to nearest: Well ...........-•- Foundation ...................... Prop. line . _......... LEACHING LINE --••••-•-� [ j o. of Lines ........................ Length of each line.___-• Total en 0 'D' Box .._. ....... Type Filter Material Depth Filter Material . Distance to nearest: Well .. ....:--'Foundation. - ...... Property Line SEEPAGE PIT O Depth ,, ...-•............. -- ....,-..._....•.... Diameter:: ................ Number _ Rock Filled Yes C7 No (3 Water Table Depth .. Rock Size ......................... Distance to nearest: Well ......Foundation ....-----••_... Prop.op. Line ....................... ;- REPAIR/ADDITION Prev. Sanitation Permit,4E r Septic Tdnk (Spec fy'Requirements) ..... Disposal Field (Specify Requirements}�-,': '_•--_•.-,--•-••--_-_• _... f • •- •---•.........................................•--............--......-•----..._.. ..... ��.: ...........•.......---••-.......-----.....---......----•---..._....._..-•---------_.---- --•-----------_...... .......... .....I.......I........__„--..........__...-_.........._._......_....--................_..._......._-......•...-_._..........._........._--....._... (Draw-existing and required addition on reverse side) I hereby certify thats,l have prepared this-application and that the work will be done in accordance with San Joaquin County Ordinances,State Laws, and Rules arid,Regulations of the San Joaquin Local Health District, Home owner or licen- sed agents signature certifies the following: ., "1 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's Compensation law: of California.” Signed ...-_-..._. . Owner If oth t •-----•-•--•------------- ---------- ........ .....:............................ an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. .... .. ..... •• _ BUILDING PERMIT ISSUED ............................ DATE'...._`1!"�r --.7 ............... ADDITIONAL COMMENTS ............ ....... .DATE......... .....................••--------....._•---• ..----•-- ••••-•--:-•-_- - = LFinal InspecoDe . :.............y: A-11, a ---- SAN JOAQUINJLOCA i HEALTH DISTRICT E. H.13 241-'68 Rev. SM