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a FOR OFFICE USE: { - APPLICATION-FOR SANITATION PERMIT Permit No. ...�. :.`�$.�. j ............................................ .... – (Complete in Triplicate). ..............................................• Date Issued ......�':...."1•. 4 This Permit Expires 1 Year From Date Issued ✓ Application is hereby made to the San Joaquin Lucai Health District for a permit to construct and install the work hereir i e in compliance with County Ordinance No. 549 and existing Rules and Regulations: described. This application is mad JOB ADDRESS/LOCATION ...1.�.6..02....5�.... . r CENSUS TRACT ..S`... _ ...... � IFF—S................... Ph0 a Owner's Name ....DEINN. .............. .. !, C s ...... ...................................... Address . ....��.b- Z........5....... � ��.V L..__.......City:...: Contrrctor's Name.... .......................... ........Licen e# ........................ Phone .............................. O.vv/J ........ . Installation will serve: Residence partment House C1 Commercial ❑Trailer Court D Motel ❑Other.......... ................................. Number of living units:............ Number of bedrooms ............Garbage Grinder ....._ .... Lot Size ............................................ Private ............................... ❑ e Water Supply: Public System and name ......................... Character of soil to a depth of 3 feet: Sand❑ Silt❑ CIQY q, Peat❑ Sandy Loam ❑ Ony loam ❑ . , If a....... ................ A Hardnan r7- Adobe Q .Fil(Material yes,type .... A.� locolion o� system in relatia�� to wells, buildings, etc. must be placed on reverse side.) (Plot plan, showing size of lot, s is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer ti SEPTIC TANK[ ] ize......... ----___._•.............:. ........ Liquid Depth .......................... PACKAGE TREATMENT ( ] pacity .................... Type ........- ...... Moter(al.A..... No: Co partments Ca Distance to nearest: Well . .......... .......................Foundation .................... Prop. Line...................... y. jLenf each line.......... ................. Total Length LEACHING LINE [ J ,No.�of lines ................. _ gt i o D' Box Type Filter Mated I ......... .......Depth Filter Material ..............._.......................... Distance to nearest: Well .............. ......... Foundation ........................ Pr party line ........................ s SEEPAGE PIT ( j Depth Diameter ..... ......... Number . ............... .......... R k Filled Yes b No Q 3 Water Table Depth ..... ........Rock Size .................... Distance to nearest: Well ............ ... .............. Foundatian .............. . .. Prop. Line ...................... D REPAIR/ADDITION(Prev. Sanitation Permit# --..---• .................... [late ......... Septic Tank (Specify Requirements) -- •.... - -....( . w x )0.x-a_ Disposal Field (Specify Requirernents) --• ............ .....4..".. .. ......... r ...'..r. ........ ....... ._ ' .......................... ..'-- ........................................... ............................................ (Draw existing and required addition on reverse side) I hereby certify that I he re 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 frrtifies the following: "– r which this permit is Issued, I shall not employ any person in such manner "I certifyat in the performance of the work fo as to b c subject'toan' Compensation laws of California." Signed .... �..................... .... Owner ` ;. • Title . _.. . _......................... ................................ (If other than owner) FOR DEPARTMENT USE ONLY — _-__ APPLICATION ACCEPTED BY .,. I, I ... . . ................................................................. DATE....._ ..' ..... ... .......... BUILDING PEP.MIT ISSUED.......................................................... ................................................DATE...•....._..... .......... ADDITIONAL COMMENTS ................._..........._._._;...._.........................,..._.......................... ........_........................ ..... ...... ... ... .. ..............Date _.... .. . �.... Final Inspect . ..... . 2CZi � .. SAN JOAQUIN LOCAL HEALTH DISTRICT '� E. H. 9 1•'68 Rev. 5M