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f FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT ........_........._..-•................................ ICo`mplete in Triplicate) Permit No. _- ..............�-...-.....-------....... � 4-, pato Issued ............... .....-•---............................................... This Permit Expires I Year From bate 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: JOB ADDRESS/LOCATt ..,�..,f• p -...,.fk. F1,9. -..............................................CENSUS TRACT Owner's Name ... Ll ---•-�j ' Ph ----- Address ... .................... .._.. _.._........city ... .......................................... Contractor's Nome ................... 4.'..s6 ....................License y .-3. ... Phone Installation will serve: Residence Apartment House] Commercial QTraller Court 0 Motel Q Other - Number of living units:..../...._ Number of 3'.--Garbage Grinder ............. Lot Size ...... ................................... ' Water Supply: Public System and name ....Private I Character of soil to a depth of 3 feet: Sand t} Silt Q Clay ❑ Peat Q Sandy Loam Q Clay Loam Q Hardpan 0 Adobe Fill Materia) ............ if yes,type.............I. ............ (Plot plan, showing size of lot, location of system In relation -to wells, buildings, etc. must be placed on reverse side'.)O NEW INSTALLATION! (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 4 PACKAGE TREATMENT [ ] SEPTIC TANK I I Size._....:................ .-_-.-_. ............. .. Liquid Depth ........................... Capacity .................... Type .................... Material...................... No. Compartments ...................... Distance. to nearest: Well _....-•.............................Foundation ....._................ Prop. Line _..._..._....:.....:. _ .... ._. LEACHING LINE [ } No. of Lines K.--._. ..__..I...... Length of each fine............................ Total Length ............................ 'D' Box ....... Type Filter Material ....................Depth .filter Material .....:...................._.._...._......... • Distance to nearest: Well ........................ Foundation ........................ Property Line •--------•------.-..-__- SEEPAGE PIT O Depth ..........-.........`Diameter ................ Number ....... .................. Rock Filled Yes ❑ No (3 Water Table Depth ....Rock Size Distance to nearest: Well ........................................Foundation .....................Prop. Line ...................... l REPAIR/ADDITION{Prov, Sanitation Permit# ......... ....-----•--•-----••_-_...... Date 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 dome In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health;District. Nome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California',' ........:...............Signed .................................... ......Owner er By ....... Title .:............................ (If other th o ned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... . . . .. :_ ... ........ DATE /,.-Z-..:: _ 7 -- BUILDINGPERMIT ISSUED .......:........._...._........._.._-•------•-...-=----•-----..__...._._...._...--..------.:.-._.__......_DATE ........................................... i ADDITIONAL COMMENTS .....-----•------------- ----------------_..------.....------..__..-.-.-.__...-..........-.....-._......._.. ..------ - -- -------------------- _-------------- .......................••-•.....:._.........-_. ---------------------------- Final inspection by: -.. _-. - . ,, EH 13 2!t 1-68 it-v. 5m �. ..............................-..Date SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7$ 3M I�