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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ~_ ,. ICamplete in Triplicate) Permit.No. .. �L _:�-� .............. ....... . - ........... ' .......................�.... This Permit fxplres t Year from Date issued Dare issued .....T.3�'7'� 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. ; JOB ADDRESS/LOCATION .:. ... ...... .. �a ................. ......................CENSUS TRACT ....,..,.................. Owner's Name Ll Phone ,. -_.... _. ........--•................................................ ... ..... . . Address . . ........... .�o..� City 4 Contractor's Name ................. �KxC�?r .........License +, �{:a�3..--- Phone 116 Installation will serve: ResidenceP�Apartment House❑ Commercial❑Troller Court Motel ❑Other ............^.............................. Number of living units:...... .... Number of bedrooms ___..Garbage Grinder ............ Lot Size .. _. X. 3................... Water Supply: Public System and name ..................-•`-•................................._........__...-_.....................................Private ❑ Character of soil to a depth of 3 feet: Sand 13 Slit 0 Clay ❑ Peat E] Sandy Loam ❑ Clay Loam ❑ Hardpan -Adobe Fill Material .... ....... If yes,type ............... ............ � t (Plot plan, showing size of lot, location -of system`In relation to wells, buildings, etc, mu4t be placed an reverse side.)f N�W INSTALLATION: No sep#it tank or seepage pit permitted If sewerIsavailable within 200 feet,) W .+ F r PACKAGE TREATMENT j ] SEPTIC TANK ... Liquid .Depth . ..�........... r (� Size._.... �� K... ............ ;. Capacity _- Type lS - Material.. No. Compartments y........._ �t .... . ........... ... Prop. Line L Distance.to`hedrest: Well ------------- -_-_-----------_-: Foundation ----.IQ------. --�.:f ........� LEACHING LINE P., No. of lines _.-._ _--------------- Length of each line-.-..-...................... Total Length 'D' Box Type Filter Material ....................Depth Filter Material ......................I.................... Distance to nearest:.Well .......=........._..... Foundation ................... Property Line ....................:... ,SEEPAGE PIT [ 1 Depth .----------------- Diameter .......r,__e.:_.__'Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth .....:_--•.:_--- - Rork Size _--_-....� �Foundation�:.... •-• Distance to nearest: Well ...................... ------ Prop. Line ...................... �RE@AIR/ADDITION(Prev. Sanitation. Permit# _............................................ Date ----------------------•-• - •I ..�� pp Septic Tank (Specify Requirements) _._: .._ � ___ .. ...... _.. � _� ., ••o ,-.Cc Disposal Field (Specify Requirements) ------------------------- ------- --- •-- -- i ----------------------------------- __.... T1 ;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 Rules and Regulations of the San Joaquin Local Health:District. Ham* owner or Ileen- 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 II as.to become subject to Workman's Compensation laws of California." Signed -- •• _... .. . -•------------------•-------------- Owner llt BY = . Title - :.................... (If oth t an ownerl DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _..- ---------- DATE ...`.....�2.'.7.-_ BUILDING PERMIT ISSUED =. _ Y -�� /: . ----------DATE .... ::............... ADDITIONAL. COMMENTS --- � ---- --- ---- --- -- --• --------•---.._.. ------------------ ------------- �- Final Inspection b �_._.. . p Y -------------- ----•-Date EH 13 21 IL-68 Rev. 5mf SAN JOAQUIN L CAL HEALTH DISTRICT 8/7l, 3M