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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT •�U_a[� 1 Permit No. --------------------- --- - 7 ---- ------------- (Complete in Triplicate{ ` 2-0F ,- - --------- Date Issued '"r r This Permit Expires 1 Year From bate Issued - ealth rict for a permit to construct and e work rein Application is hereby made to the San Joaquin ian ecwitth CounDtytOrdinance No. 549 and existing Rulestalnd hRegulat ons: described. This application is made P JOB ADDRESS/LOCATIO ..- , ��i° �` C��_ -C,, � ..CENSUS TRACT ---- --'---- _ ---- - Phone ----- ---------------------- Owner's Name e-4 f1ic., a - C�w �- . ,_ 4/ r��•��-�--- ��-�-- ------. cit - - --��--- --------------- ----- Y --- - -51k r- Address --------- / IV - - ne f - ho =- Contractor's Name - - --------- ------ ---------------License # r�. a l� Installation will serve: Residence partment House❑ Commercial :❑Trailei Court Motel ❑ Other -------------------------------------------- Lot Size - . / __.Garbage Grinder --�--- - Number of living units:------ Number of roo s private ❑ Water Supply: Public System and name .-- -- A`-- - _1V ❑ y Clay-Loam. Character of soil to a depth of 3 feet: Sand (_] ilt❑ Clay Peat Sand Loam ❑ ❑ ! Hardpan ❑ Adobe' Fill Material --------- If yes, type ---------------------------- {Phot 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 public sewer is available within 200 feet,) a� Size-______ Liquid Depth x PACKAGE TREATMENT C ] SEPTIC TANK:[ ] ---------------- q p Capacity - Type --- --------------- Material------`------ No Compartments. .. Distance to nearest: Well ----------------------- ---- Foundation . "_ -----:, Prop. Line Length of each line. -------- Total Length -----------•--------------- LEACHING LINE [ ] No. of Lines De fih Filter Material ' ----------------------- -------•---- 'D' Box ------------- Type Filter Material -------------- P , s -_Property Line Distance to nearest: Well .............__.--___-- Foundation ----------- I I De Depth -- _ ---- Diameter ---- Number ------------- Rock Filled Yes 0 No.0 SEEPAGE PIT [ ] P ----------�- Water Table.Depth ------------------------------------- ------- -Rock Size ------------------------- a Foundation Prop. Line ---------------------- -:----------------- Distance to nearest: We ---------------------------------------- •$.. ►_ - ) ' - ------------ -- .Date -=-- -----_-----------=---_----- REPAIR/ADDITION(Prev. Sonitation Permit#�--------------- _ : -= -- --------------- Septic Tank (Specify Requirements) ------------------------- _ --------'- Disposal Field (Specify Requirements) J._... '----=• ...t - - -------------- - _______________�-.._ -...--------------}---------------- ,�..-----'--....._....-_-..._..__-...__...__-.... {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. Home owner or licen- sed agents signature certifies the following: , "I Certify that in the performance.�of the work for which this permit is issued, I`shgll not employ any person Rsuch manner as to become subject to Workman's Compensation laws of California." Signed -------------------- -- ------- ---- ------------------------------------ Owner - - - ----- - - - ------------------ T - -------------- -------- itle ( er than owner{ _ ARTMENT USE ONLY DATE -------A -/,!(=/-d------------ ------- ---------------- APPLICATION ACCEPTED BY ----------: -------------------- - --- BUILDING PERMIT ISSUED ----------- -------------------------------------------- --- - ------DAT - --------- -------------- -------- ------ ADDITIONAL COMME TS ------- - - --- n;----------- ----r------ - ----------------------------------- ----------- f - 3� - 5---------- --- --- -------------------------------------------------------------------------- --------------------------------- --------- = --- -------------------------------------------------------------- --- ----------- - -- _ ------------ -------- ------- --- _ _ Date Final Inspection by: . --------------- - ----- -- --- -- "------------- _ _ JOAQUIN � LOCAL HEALTH DISTRICT S E. H. 9 1-'68 ev. 5M. b',.