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. FOR OFFICE USE: APPLICATION. FOR SANITATION PERMIT ........................__........ ...........: Permit No. ......... .l�.Z (Complete In Triplicatel ................................................ This Permit Expires 1 Year From Date Issued Date Issued . -. _ ... . Application is hereby made to the San Joaquin Local Health District for a permit to construct and'install the work herein E described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT ON. ..c _ n.. .&..._..r .. ................CENSUS TRACT ...............,.......... A Owner's Name .. ��...... .................................... .......: _...............Phone ............................ ...... Address --_..-----.:Jwd�_7. !' . ••-- ... ........................................ tl City .. .. ._.! _ Contractor's Name .._ zie _ _ Lioanse # 1:��.,��?-e�__-- Phone Installation will serve: Resi ence(Apartment House fl Commercial oTrailer Court 0 Motel ❑Other............................................ Number of living units:.:._..f:l._ Number of bedrooms ....-4 ...Garbage Grinder ------------ Lot Size .....�.f. - Water Supply: Public System and name .................... .. - .. ............................... ................... ..................Private Character of soil to a depth of 3 feet: Sand❑ `Silt O Clay p Peat❑ Sandy Loam ❑ Clay Loam ❑ O Hardpan 'Adobe j] 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.) ION: IN* septic tank or seepage .pit ,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT S �' W INSTALLATION: TMENT [ ] , SEPTI TANK�I Size,s��,fl1. .. X_... :�--__--- Liquid Depth ...��. ..... Capacity ---- _Q._ .----•- Type :)Zx- MaterialNo. Compartments .. . Distance to nearest: Well ------------ ..........Foundation ......1. ? --- Prop. Line ....... ..... LEACHING EINE °[j�/ No. of Lines -------2_____________ Length of each line. ? ....... Total Length ..- t - ' •.------ •............................ 'D' Box ...�.-.____. Type Filter Material ....S.1Z ..Depth .Filter Material ��_ t Distance to nearest: Well __.._._ r ?`.... Foundation ----J.o/,/ .... Property Line ..�,// ...... SEEPAGE PIT [ ) _----- Rock Filled Yes 0-;' No Q Depth --- . '_. .._.. Diameter ...! .._-- Number __.._...... ...._ Water Table Depth ------------------------Rock Size ... Distance to nearest: Well --.--•- -C2 ---------------Foundation ---Lo.. .__ Prop. Line ------ ------ REPAIR/ADDITION(Prev. Sanitation Permit* ---------------------------------------- - Date --.-•.•---- ) Septic Tank (Specify Requirements). ..................... ................................ .........._.......................... Disposal Field (Specify Requirements) ------------------------ ----------------------------- _........---.........................,................ .------------------••----- .---•-------------..- IDraw existing and required addition on reverse side) I 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 and Regulations of the San Joaquin Local Health:District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not amploy any person In such manner as to become subject to Workman's Compensation laws of California." Signed __-.------- - Owner . By -------- ---- . ------------- Title _.. _.. .............. (lf other than owner) �+ FOR DEP4kRTMENT USE ONLY i APPLICATION ACCEPTED BY --- h ' ---------------------------. 'DATE $.• t .,�--------------------- BUILDING ADDITIONAL COMMENTS ............................................................. ::..._.. PERMIT ISSUED --------------•---------.._----_....._. _.. DATE _....-•................... .. ---------•---- ---••-----------•-••---••---------- ----------------•----------- ..... ------------------------------------------------------..._.................................. ---- N-_... :. Final Inspection b pp l' y: .. k ...... .. ...............................---...........•---.....---------•--•--........:::.....Date .. . .................................... EH 13 24 1--68 Fay. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N