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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . (Complete in Triplicate) Permit No. 3... _... ............. ` ................... � _.T" --- This Permit Expires 1 Year From Date Issued Date issued ,. __ 1rf:? Application-is hereby made.to the San Joaquin Local Health District for a permit to construct and install the work herein a;described, This,�appiication'�is� made in compliance with County Ordinance No. 549 and existing Rules and Regulations: __.,_� } JOB ADDRESS/LO TION ....... CE TRACT ..--• -•... CENSUS............. Owner's Name �.w 1....................... !�"� ' Address Ct.C.N d rJ_ �4 e Cit € Contractor's Name ..C4.5-•� ..5.# t. csr .....license#cSI_G Ph ' one .. Installation will serve: Residence6 Apartment House-[] Commeriafl C]Tratler Court-,0 1 a Mot, [-]Other ....-- ••-------------•- -Number of j living units:....f._- . Number of bedrooms -- ......Garbo e Grinder �jot Size ................ Water Supply: Public System and name ....: ----------- --- Private, -- --- �-.-------..- _------------- - ---• _.-._ . . Character of soil to a depth of 3 feet: �-5an¢¢d 0 Silt 0 Clay 19 Peat ] Sandy Loam 0 Clay Lam [] _ Hardpbn ❑ Adobe ❑ Fill Material . .......... If yes type {Plot plan, showing size of lot, loeation of system in relation to wells, b ildings, etc.' must be pll ced on reverse side'.) } NEW INSTALLATION; (No septic t nk�or seepage pit permitted if public saver is v ' f t t p ! a a�lable within 2.00 feet,} L ,. PACKAGE TREATMENT [ SEPTI •TANK'.[ j Size _ .of ----- r,��.. 7f T _ C� Liquid Depth ..44._L............... Capacity .fyZcrq.� . Type. : : Material-��-mei!+ .._ I No. Compartments _ -- ------------ N . o Distance a neareIt $ Well Length of each line . tion �� op. Line ., �. ��-..--- •----..Fo.undd f .... W Jr LEACHING LINE -[ ] No. of lines }` �: ....... . Total Length .1..70` I '•DBox . " ` • -... . Type Filter MateriaJl C ¢v. -.• thFilter Material � ��-•- � Foundation I �a� ............. Distance Distance to nearest:"Well ...7 :.^. -- .- _/ . ..----. Property Line .& ............... SEEPAGE PIT Depth /.��- - . ......# Diamete/ Z.�..�Z•-- Number . .. � . Rock Filled Yeses No ❑ " Water Table Depth _ID.U..____.__•- ----------------------Rock(Se--.P'L-:. �_ . .............. Distance to nearest.�Well - Found"tion r _ Prop. Line ....._............... REPAIR/ADDITION(Prev. Sanitation-Permit# --._.--- ... �. . I • -- ---•----------------- Date ----�-~ -•-------•--- --- - r Septic Tank (Specify Requirements) ........-..............-.-.-.-.-..-.-.-.-.-Z... #• --. ....................... . ............................ ............................... _._.... ------------i Disposal Field (Specify Re`guirenients) -I.._..._._ q !` ---------- fi .. ................ .... . .. ..�- ..------ ... ... ------•---irk ...--- ......-- --......-- J ............. existing and required addition on averse side} r I hereby certify that I have prepared this application and that the�workifl be done in accordance with San Joaquin County Ordinances, State Lows,rand RulesandRegulations-of the San Joaquin local Health District. Home owner or licen- sed agents signature certifies the-following: 1. j "I certify that in the performantel of the wrk for which tki`s;iermit is issued, I sha�1not m (o an e employ y p son-in such manner as to become subject o Wo krnan's mpensation laws of California." --� i Signed -. �- ...•.�----- ..... ----------------- ------ ------------ Owner BY ;.... ... Title .... - � -•----- ------ --- r , other thanEo der} ' --'--' --------- (if � ../ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED , -. ( i BUILDING PERMIT ISSUED ._. `'�`'_` . ............. .' . ... .-. DATE .. .. +�� Q.- .._. ..__ .._ -:-. .(..DATE -. ..... ....... ADDITIONAL COMMENTS ......................... '- -- ---•...................... ....... .............._..-.-- i ---...- . --- . .... .... .............:.... ...............•------- Final Inspection b V p y: .. -- -- -------Date ._.. -. ..�.._.. - r _ SAN J AQUiN LOCA HEALTH DISTRICT E. N�13 24 1-'68 Rev. 5M-