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"FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete In Triplicatol Permit No. .- ......a.I�.. This Permit Expires 1 Year From Date Issued Date issued .......,12........ 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: r JOB ADDRESS/LOCATION ...... ..6.6 ...�� . . ...V.,4x......._44.44........................CENSUS TRACT .......................... Owner's Name ...6)&-6.e,.&,4_. ...... 4..�. .........................................................................lahonec. Address ...........x.3.1--.3_-..... .�.�+t_.�..-_......�.I'? .......................... City ............................................................................ Contractors Name ........S4�k............................... .... License # ........................ Phone .............................. Installation will serve: Residence�rtment Housefl Commercial{]Trailer Court 0 Motel ❑Other .................. .......................... Number of living units:...I....... Number of bedrooms .... ....Gacrbage Grinder ...... Lot Size ........ ?`% ............�` Water Supply: Public System and name .............................................................................................................Private Character of soil too depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam o.. Clay Loam Hardpan ❑ Adobe ❑ Fill Mater€al ............ 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 seep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size—.................................... ........ Liquid. Depth .......................... Capacity ....... Typep.We4lk Material s No. Compartments ......................r ........ Prop. Line ----....... � _.Foundation �� istance to nearest: Well .... ....1_. ......___________ LEACHING LINE [ No. of Lines ---..��.•-------------- Length of each line...._/00.�___._..... Total length .._. ........... 'D' Box .... Type Filter Material 4-P44akepth Filter Material .... .... . Distance to nearest; Well _Jejv............... Foundation ... ....... Property Line _110...r...........P l� Depth --- Diamefier ` . . Number - ......... . . ................ Rock Filled Yea �o (3,{ Water Table Depth ........... ....................................Rock Size ................................. ly Distance to nearest: Well .......16. .......................Foundation -----_ _-.......... Prop. Line ...................... "► REP�AIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .................................. ) SepticTank (Specify Requirements) ................... .................... ........................................................................................7 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 done In accordance with San JanquIn County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heallh.District. Nene owner or licen- sed agents signature certifies the following: "1 certify that In the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco blect to Work n's Coensation laws of California." Signed '.-- 'rJ- w�--- Owner By ..----_----------------------------------------------- •----•----•-,•------------- Ji ------- --•---- -------------- ............................. Of other than ownerl -FOR RTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- •--------------->---------- DATE �� 7 ............... BUILDING PERMIT ISSUED .............................. -------------------DATE ...-....--------- - ---- ----...._..__.. ADDITIONAL COMMENTS .........--------..-._.-------------------_-- .._..__.._... ---------------------------------------------------------------------------------------------------------.................... -•--------------------•--- ------- --------------•--------------- .............---- ......... finalInspection by -•----- .......................................................................................................................Date &... ..... --..-..-..----- ' IIi 13 21s 1-68 ikv... 5M---; AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M