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FOR OFFICE USE: APPLICATION.�FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .. 3.` �d .......................•--•......._............... . _.................1......__.I..._...._.._..._ This Permit Expires 1 Year From Date Issued Date Issued 67-11 Z3.. Application is hereby made to the San Joaquin Local Health District-for a,permit to construct and_instald the work herein described. This application is made in compliance with County'Ordinan,cis No. 549 and existing-v ergo diRegulations: JOB ADDRESS/LOCATION C� ,d �l Owner's Name ........�... ........... ........ . .................. NSUS'TRACT... Address ------- ,� _. ,- ne ------ .................. ............. }'. --....•................ city .�71'e14 r .. . . -- Contractor's Name 1� --. �� C.................... License # . 719. Phone Installation will serve: 'Residence[X'Apartment House 0 Commercial [(Traller Court �] L / ( Motel-3 Other ..................... Number of living unit s; f••. Number of bedrooms _ a-Garbage Grinder --- Lot Size /__. _._.. &".��•--- 1 Water Supply: Public System and-na}m.e ...____. ,-.•_•--r-••�-':_ i ......._............ .......••••-•------••--.......................... - - -------Private ' Character of sail to a depth of 3 feet: Sand. .. Silt[] . Gay [] Peat❑ Sandy Loam ❑ Clay Loam Hardpan Adobe &I Fill Material ----- If yes, type ....-------------------------- (Plot ------ -(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 seepage pit permitted if publicsewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK : : Siae._' t -� F Liquid Depth r- ............... �� .. : Type P Material ,,r /� r_.... No. Compartments 4 _ Distance to nearest: F Capacity t}. Well _.., ft,�r.......-Foundation .... Prop. Line -�....... 11 LEACHING LINE No. of Lines ..... _t"�,..,. Length of each line ____ Total Length �T 41.01 'D' Boxy.. ,Typo Filter Ulaterial lDepth Filter Material Distance td-riearest: Well / (� �� ._... Foundation _ ...._..... Property Line .. _ ...... . ; SEEPAGE PIT Depth _. , `_ ._. Diameter '"—5_0r_- �� r ------- - �� Num ----- ---------------------- Rock Filled- Yes No Water Table Depth _.._ e .. ..... Rock Size �4 -, • N, «,. .......nearest: Well,REPAIR/ADDITION(Prev. =,�Date�_mss.:...._.__.-•.............j - a i Septic Tank (Specify Requirements) _._._.--------- . Disposal Field (Specif lRequirements) _____________________ ------- --------------•-•------••--•-- ---- -•--------- ------ .- - ---• -------...•-••----•- -=----•. ............................................... ..- :.....__.... I hereby cern that I have re ar(Draw existing and.required addition on reverse side) ` . . y fy p p ed this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, acid Rules and Regulations of the San Joaquin-Local Health District. Home owner or licen- sed agents signature certifies th'e following: - "I certify that in the performance of the`work for which this permit is issued, I shelf not employ p y an y parson In such manner ' as to become subject to Workman's Corripensation laws of California." ' Signed .--- ...-----••. . ..... Owner By _.............................. -- :..__.,Title _. (If oth hays owner) > ..._r_------:_-•- F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._ ___ . ........ . - ...... .................................. •---••-------------- •- . DATE _...._... '}�-• ��.... :.. _... BUILDING PERMIT ISSUED ._--_....-"......:.......... - - ..--• DATE ADDITIONAL COMMENTS ._....-•------...__ ---------• ....................... --•-----..:...._...__.....__.....-•-- ...................... ................ .. . ........................ - ---•.......................... V.,/ • ... ----------•-------------•......-•--......._............._._._ ,r Final Inspection by: ! .....__.. ............................................... .............Date ... .. �T_ --. ......_.._ . .�, ------ » .,.. d:'SAN,JOAQUIN;LOCAL-HEALTH .DISTRICT " E. H. 13 24j-'6-8 Rev. 5M