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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT {Complete in Triplicate) Permit No. ...................... .............._.._......._ .._. S__•---••• ......................... y This Permit Expires t Year From Date Issued ,,Date Issued ... ......... It 0110— Applrcatior� is here 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. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATION ..._.... .CENSUS TRACT ......................•- . Owner's Name ., .tQ�..xdf '/ .. q- Phone _......................... 00 Address �. -40;�f; / -...._aS` - ---.-------•--•-------___ City .4i.-t.?� f _ .._. Contractor's Name/* ,0. VoeQa��i _ ----._..-License #r Phone Installation will serve: Residence EV Apartment House❑ Commercial ❑Trailer Court (] E Motel [)Other ..............:. Number of living units:..,(---. .. Number of.bedrooms _ 4 �r Garbage Grinder Vii . ._. Lot Size -�.lr �' ___•.-..,.-., M Water Supply: Public System and name ........----------------------_----. _._..Private,® Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat A Sandy loam ® Clay loam ❑ Hardpan ❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public,sewer is available within 200 feet, y ' S PACKAGE TREATMENT [ I SEPTIC TANK ('J Size.-. X� C_ ---------------------- liquid DepthVE............. Capacity 14v.Q. ype _Q.'_ Materia). {si'---._-.- No. Compartments .`�........... Distance to nearest: Well !`�r ,:.a. A -------------Foundation ,fes............. Prop. Line ...A4?4? LEACHING LINENo. of Lines !• ) �..- _. _ ... . Lengtl�._of, each_fine w.'r.� . Z:2;.: Total Len th j D' Box .. ,�.y Depth--I=ilter Material -f.f.._............... /-` Type Filter Material- . _ Distance to Inearest: Well _/.../�-�- "' Foundation '.ice'`........._..-- Property Line XAE .*...__ !. SEEPAGE PIT ,,, —.Depth 'Diameter ................ N tuber --------- Rock Filled Yes ❑ No C r Water Table Depth .......... •--------- ------Rock Size _........----•-•........... Distance to nearest: Well 6.._` "..............:: .............Foundation ----..- Prop. Line ..................... # REPAIR/ADDITION(Prey. Sanitation Permit# .............. .J.--..�.4`-_�:':•----- Date ---- ) '! E Septic Tank (Specify Requirements) ..................... ..-.---•-----------------.................................................. Disposal Field (Specify Requirements)"----------:--------7------......... ... ................. ------------ ------------.. ............ •-------- .............. . .................. �. .............. (Draw existing-and required_addition.on_rev erse side.). I hereby certify that I have prepared this application and that the work will be done in accordance with Son 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 employ any person in such manner as to become subject to Workman's Compensation laws of California." 4 Signed . ......... Owner f By Title . . -. f other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,, f/ . . . DATE............................. •--........._ BUILDING PERMIT ISSUED _.�_ . %. DATE . . -.•- ............ ...•--..... .. ..............----...... ADDITIONAL COMMENTS -.'`. =-•---- ------------------------- _..-•----. .......... - -------------- . ... -- ------------------------...--------- •----- -- Final Inspection by: .................. ........• --------- ,%_ ..L._ r4. -•--_----------------Date _. .._.__.... . JOAUIN LOCAL HEALTH DISTRICT E. H. 1-3 24 1-'68 Re%��--stii 1..? 1-1