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�•_ Rill OFFICE USF APPLICATION FOR SANITATION PERMIT 7r,1�8513' ( �r J. Permit No. ..................... `" IComplNe In Triplicate) .. . �..._.. .__....... Date Issued ..--�'� This Permit Expires 1 Year From Dot*lssueB 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 Regulatiotst p _- - CENSUS TRACT -------------------------- JOB ADDRESS/LOCATI 1. - �. •-...y- a .................... , Owner's Name -•...............•---.... :. . .---_.... ................ .:. .................................. Address - .City ............ _ , .. Contractor's Name .. .._ : .. o+_.i!< ..-.License#� �.='3 .y�ltosle ................. Installation will serve: Residence❑Apartment House❑�CommetcI sal OV00ef Court ❑ Motel 0 Other s��.Q. - GOdXWe Grinder . -. Lot Sire _. r Number of bedrooms .. ____ _+r-- •.-..�...__...-- Number of swing units: . ^�� Water Supply: Public System and name . -.--• .........................Private Character of soil to a depth of 3 feet: Sand 0t❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loom ❑ 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 seegage pit permitted if public sewer is available within 200 feet,) �a,J( 0 f PACKAGE TREATMENT ( ) Liquid Depth . .. _._............ SEPTIC TANK Size.? �I..._..-•--�-- ��---- -.. . . . Capacity 106 ejr e'&k Type 'fie'"'` .. Material No. Compartments ............' Distance to nearest: Well .� ._�.................Foundatiwt _ .L Q...f .. .. Prop. Line ... LEACHING LINE (o�/ No. of Lines ?3 Length of each line g . . _ - - Total Length ... 'I]' Box Type Fitter Material ...$ - ......Depth Filter Material ... 11 .lf............. r . Distance to nearest: Well ... �+� .......-..... Foundation L�1..--_.-----. Propert)/ LNte .. ................ PIT Depth L�-V ------ 'Diameter _ y �.`..: Number #sck Yes Q t Water Table Depth Q--......_.....................Rock Size .._../. .... ...._..- Distance to nearest: Well ... _._. _C _ -------------......Foundation - .-/..a-' ....... Prop. Line ---- ......._....... Rlif Alll/ADDITION(Prev. Sanitation Permit# ........ ... .._..... ..................... Date .-.---___-------..__,�._.�__..) Septic Tank (Specify Requirements) ..-- ...................................................•----..._........_._......._..........--_ ............._................. Disposal Field (Specify Requirermentsj ..................................................:...................... -----_.. ... _. . _-.................................... .......... ..... .------....._....I........-- (Drdw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the wo& will be done in accordance with San Joaquin County Ordlnonces, State Laws, and Rules and RegulaHens of the Son Joaquin Local Health District. Heine owner of Ikew sed agents signature tertians the following: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person fit such mGnaer as to become subject to Workmen's Compensatiers laves of Collf0mia." Signed -------. Owner r (ff other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - . --..... DATE S ...E"� BUILDING PERMIT ISSUED ... . ............... DYE DDITIONAL COMMENTS .. .hC .7. _ ._..� _.. i...._.....E1.°_.... '!�.. . .. ...........................I---------._..-_.-----... ---._-. -------------- .... r -A...... sesG'7� �r .. ---- .._..----------------------------•......................... .................... ..... .........-............................ .. ----....._.. . ............................ FinalInspection by: ....._..-�Ei_r'..................................................................................................Doh.. pf{/ ......._........ SAN JOAQUIN LOCAL HEALTH DISTRICT F. H. 13 24 1-'68 Rex. 5M w 7/72 3 M