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FOR OFFICE USE: ' ^/ .. APPLICATION FOR SANITATION PERMIT w A" - .._...._._. {Complete In Triplicate) Permit No. .. � :.......... Cj r This Permit Expires S 1 p res 1 Year prom Date Issued Date Issued ... `6__ , f Application is hereby made to the San Joaquin local Health District for a permit to construct I work herein described. This application is made in compliance with County Ordinance No. 549 and exing Ruleand standle ufations: nn 7e9 s. JOB ADDRESS/LOCATION .---... C7 V s Name .L...... --...CENSUS TRACTOwner' �-e i .'. -T`=� _.... ._. ._ Address .................. (?.f�. :. _ ,-...._._.. Phone _ ��. ....... Contractor's Name .' _ .....----••• - { %L -�: Lic�ense_ ` _- _ ..---:Phone- ��6T�_.......__ k Installation will serve: Residence�(Apar#ment House fl ComT ercial frailer Cou, — -, s.. Motel. - _ �� . . l a(]'Other }:. -----/ ....__... .--• Number of living units:...__-__- Number . o�bedrooms � I i ••••---. rbage Grinder,:. .._-..-. Lot Size 7 Water Supply: Public System and name '/� . .. Character of soli to a depth of 3 S ..._.._'...._..__}._ ._�. .............. .... (] fest: anti[] Silt 0_y_0,/:Peat pSandy Lopm 0.. Clay Loam ❑ Hardpan 0 ' Adobe "'Fill Material. � 3 If yes, ............... ............ " type �► ' (Piot plan, showing size of lot, locatiori of system in relation to wells, buildings, a must be placed on reverse side.) NEW INSTALLATION: t I r (No septic tank or seepage pit permitted if public sewer is vailable within 200 feet,) PACICAGE TREATMENT f J SEPTIC TANK ) Size...... .... - .....•..X... • � I Liquid Depth Capacity - t TYP. ..... --••--=•�'Material---.... •-- _ No Compartments Distance to nearest: Well y.�1--- . .,..Fr ndaticn Line ............... -- . .. . m ..-- LEACHING LINE � .i' •--•-•6 [ ] No. of Lines .__..._. - Length�of each line.._........•_• .... Total Len ..................... Type Filter Ma#erial ....---Depth Filter Material - . . ......---... F � # Distance to nearesf,-Well"':?--•---=. "Foundation .................... ... i i SEEPAGE--- IT [ � P � Dsameter� � Property Line ........................ Depth ---------=---••----• Number ••. Rock Filled Yes L7 No Q I Water Tabic Depth ......-• ...................-•-....................ROCK Size r 'Distance to nearest: Well ------------- .......................Foundation RIrPAIR/ADDITION(Prey. Sonic tion Permit P Line ................... Pro i r a ...... Septic Tank (Specify Requirements) _.. ............... ; -••-•--•-•....Disposal Field (Specify . ............Requirements) i ..------ (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be clone In accordance with San Joaquin County Ordinances, State Laws. and Rufen and Regulations of-the-San-Jeaquin,£*cal-Heatth-District. Horne owner or licen- sed agents signature certifies the foilowirig: I "I 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 laws of California." ! Signed ......... ----- I Owner BY ----- •--- - 1-1 ----- - -•- ---- --- -------•---------------•• - it1e r of r than ownerl FO EPARTM USE ONLY � APPLICATION ACCEPTED BY... .,�,_, ` BUILDING PERMIT ISSUED _.._..----•--...- DA3E .. _....,.. ---- ---- .__'_..._---.-- .-- -.- -- ADDITIONAL COMMENTS ....... ...... ..:... ... ... .. -DATE --........................................ - - ------- ------- --- -----•------ ..--- ........ ...... .. ....................._... - --- -- i ---- ---•--- •-------------------------------•----- - ._._..._....---*....... ._...__. ina Inspection by: _•.----•---.._... - . EH 13 2!� 1-68 lay. • -------------------------------........... ..._ -------------Date ..... -- .. ..�.... UIN LOCAL HEALTH DISTRICT 8/74 3M