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.KATION FOR SANITATION PEltMI (Complete in Triplicate) Permit No. ... _:__Y . - ---------------••--------•------------------ -- • •---------------___________- ---__ 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: / t'/ re Owner's NameLO ION -. � -! ( `� 1 �n- c� 55 --------..�-_ CENSUS TRACT ------ ------ --------------- ---Phone ...... Address .. L-:�-------- . ---- :` ` �j --------- ---- city - - Contractor's Name . "` }' - ------ ----- -_t'----- C . 1-.License # � �� "7Phone Installation will serve: Residence Apartment House-[] Commercial ❑Trailer Court :E] Motel ❑ Other _---------- Number of living units:------I----- Number of bedrooms __,3------Garbage Grinder .... Lot Size ----__r___ 4- -��-s'__,----- Water Supply. Public System and name --------------------------------------------------- -----------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ 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 see ge pit permitted i# public sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK � Size_ ._ I r -A----------- f "�� p r � �---�-1..,�'----- ---- Liquid Depth .--`�..........-------• Capacity .[ 'p__! r-C Type _ Material- �'_'�- - No. Compartments .��,_ _. 1 p Distance to nearest: Well _____________ �Y___--_-_---Foundation._.___/_ ..___ Prop. Line _.. _____...� DQ LEACHING LINE j No. of Lines ___._... Length of each line___...._.�_- ---- Total Length ---- D' Box --- - Type Filter Material -------$A�_!._Depth Filter Material _.___� � 1:�stance to nearest: Well __________o___r_________ Foundation ------10------------- Property Line ...........-........ Z SEEPAGE AIT [ Depth ' . Diameter _._.�.�� Number ------------ ,__._____ Rock Filled Yes [ No i❑ toWater Table Depth ------------------I b:..�-----------Rock Size --- .)...x 4---r..___ Distance to nearest: Well ----------�.�_ _. .............Foundation _.__l Qkr:__ Prop. Line _... REPAIR/ADDITION(Prev. Sanitation Permit# ________ ----------------------------------- Date -----------.._..------------------1 Septic Tank (Specify Requirements) -----•--------------•---------------•----------------------_ Disposal Field (Specify Requirements] ..------------------------------------------------------------------ ---------------- ------- ------------------------------------- ---- -----------•-------------------------------•-----------------•-••--------- ---------------------- (Draw existing and required addition on reverse side); I 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 Roles 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." >igned --- ------------------•------------�r7i.P� ---------.. Owner 3y ------ ------•----------- - - --- d .-,.� -- ------ Title -� . ...------ (If other than owner) 4. ,FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --r. - DATE - -.-/. _hi. ------- ------------ BUILDING PERMIT ISSUED ..................... ---_--_.__DATE .........------------------. - - - A DITIONAL COMMENTS ............................•---------•--.....-- -------------------------------••----•-------------...---------- ••------------- - --------------------- -----------------------•------- ..............•------------...------------------•-----------------------------•--------------- Final,.l pection by: .. ~-......:�..i;:�� '%:. Dater------` -r .•.• - SAN JOAQUIN LOCAL HEALTH DISTRICT =- H. 9 1-'68 Rev. 5M i