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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT - .a Perm i' .�`. J (Complete in Triplicate) No. � ""'/ _ This Permit Expires 9 Year From Date Issued Dote Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance w;,'1 County Ordinance No. 549 and existing Rules ant; Regulations JOB ADDRESS/LOC *- . ADDRESS/LO. 0 T N -. ..�� .. q�/.. Q.lp^ CENSUS S /`i../ FOwner's Nnme. . 3 _.. ._ . ... � .......Phone . ...... cl&ass ... ..........Cityh . . ....................Z Controctor's Name ........ ..License #/C3V.SV .. . Phone A6..-.715.6.7 ` Irstallation will serve: Residence [XApdrtment House❑ Commercial ❑Trailer Court ❑ 4' Motel ❑Other- .. ................................. Number of living units: Number Number of bedrooms . -7. Garbage Grinder .._. _.... Litt Size ...../S.' ........ Water Supply: Public System and name . ..._ _..._. __ ___._..__.___._._..._.__.. .....................................Private Character of soil to o depth of 3 feet: Sand❑ Silt p Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Material .... ..... C 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: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ J Size._. .._ ......_...... .___....... . _. _'Liquid Depth __._.................. Capacity .. ___ Type ... Material....... _ No. Compartments ...._..... .......... Distance to nearest: Well .._._._____................_Foundation .. ._._...._....... Prop. Line ...................... LEACHING LINE [ J No. of Lines _ .___.. . .. Length of each line.:..- .. . ._._.._ _._. Total Length ........................... 'D' Boz __. _. Type Filter Material __........_ ... Depth Filter Material _......................................... Distance to nearest: Well .. ..................... Foundation ..... . . _........L' Property Line ........... ...._..... I SEEPAGE PIT [ J Depth Diameter . __. ... Number _. . _..... Rock Filled Yes ❑ No [l. Water Table Depth .. .. .. __. ... . ...... Size ..._.__. ...... - v Distance to nearest: Well ............ .......Foundation __.. .. .... Prop. Lina .............. ....... N REPAIR/ADDITION(Prey. Sanitation Permit# . .. Date ... ....) Septic Tank (Specify Requirements) - !! - - - - " .... Disposal Field (Specify Requirements) .... 7 V r -- - ...... -- _ (Draw existing and required addition on reverse side) 1 hereby certify that I 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 fallowing: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such rnonner as to become subject :o Workman's Compensation laws of Cal;!ornio." Signed .. . .__ _ Owner ^ JJ Y I — Orather n owner) T - R DEPARTMENT USE ONLY APPLICATION ACCEPTEDB" �i>�s-�s.G✓� . DATE •v '-.. J BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS /,/ Final Inspection by. �zvrL�% " Dri, SAN JOAQUIN LOCAL HEALTH DISTRICT E H 9 1 68 Rec. 5M