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FOR OFFICE USE: � APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit.No. .............. c� - � .... This Permit Expires I Year From Date Issued Dab Issued .................... 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'Regulatlons: JOBADD 55/LOCATIO •�/.��7 n ' `4 -_.... ....l� s........... ......................CENSUS TRACT ........... . ........ I Owner's Name ..: ... :/[-- % ......... .Phone .�. Sr9. ... Address 7.a .�. .. ... .KK:......l.............. - City Contractor's Name .............. _ '_ '!. L/..............-. .Lirense 'f. .... � I � _ Phone Installation will serve: Residence bi(ApartmentHousefl Commercial❑TrailerCouit �] !!° Motel[]Ckhei .............. 17 Number of living units:_....r;i-.__Number of bedrooms .....Garbage Grinder ............ Lot Size ti � �!/L?� ......... Grinder .�" Water Supply: Public System and name Chttrac►erofsoil . .. .......to ....................... r...�f..�.... to a depth of 3 feet: Sand ]T Sih(3_ Clay_❑ e_ •at SandyLoom W _ loam, .•' Hardpan❑ Adobe'p Fill Mc+t�ial O'.� C �.:.If.yes;type .......'Y ........ �~`~-•�, i (Plot plan, showing size of lot, location of system in relation to wells, buildin4s;-etc.1 must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is avalloble within 200 feet,) PACKAGE TREATMENT # SEPTIC TANK _. i { ] '� � Size........................... . ................. Liquid Depth ........................ Capacity Te yP ..... Material...................... No. Compartments —� Distance #o nearest.• Well ...... ...Foundation . ...............5_.. ................... Prop. Line . LEACHING LINE [ ] No. of tines Length of each llne.__..... ty ................... ........ A of Le Length nt , _J D' Box A---__Type -Filter-. .............:......Depth Filter Material Distance to nearest; Well . ......... . Foundation....................... Property Llne _:.--:. --� SEEPAGE PIT '[ j Depth ............... Diameter .............•- Number Rock Filled Yet ❑ No (] Water-Table Depth Rock Size Distance to nearest: Well ........................................Foundation :..... REPAIR/AD . Prop Line ...................... DITION . . aionermt .............................. Date . Septic Tank (Specify Requirements .................. .. ........... ............ -........................................_ t Disposal Field�_(5peci�,,Requireraentsl ' -C ..... L .......................................JFK .-�---'-------=-----=--=-•t•--•-------• .._.. _....----....._............................. j---•-•- ....................._._....:... ........ •� ;i raw existing and required addition on reverse side)'. y I hereby certify that 1 have prepared this application and that the work w111 be done in accordance with San Joaquin County Ordinances, State Lewis, and Rules and Regulations.of the San Joaquln Local heaHh.Oislrict. Herne owner or liattt- 11 sed agents signature certifies the following: "I certify that In the performance of the wo*'for which this permit Is issued, I shall not employ any person In such manner as to become subject to Worknion's'Compensation laws of California." Signed w . .. ....:.. .. ............ Owner By ._.. ,.•7itle ------------- F• ........... ..e.................. of er th wned DEP MENS f? ONLY APPLICATION ACCEPT B .....:. DATE 7 - BUILDING PERMIT-ISSUED ...."`-_............... ...................... :.._....,... DATE .................................... :. F ADDITIONAL COMMENTS .._..._ .......__.._...___.._ - - ..----•-.......11............-_ • •••--•• ...............• -••-•••. --• --- Final Inspection by: --•---- -•... . ---------. ------- ..........Date ......l .. -.,. 1H 13 2� 1-68 Rev. SAN JOAQUIN t_OCAL HEALTH DISTRICT 8/7]t 3M