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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Na. � �`3 . � (Complete in Triplicatol ; This Permit Expires 1 Year From Dote Issued flats Issued)// • Application is hereby made to the San Joaquin Local Heal#li District far a permit to construct and install the work !retain described. This application is made in compliance with County Ordinance No.549 and existing Rules and Regulations: JOB ADDRESS/LOCATION:2e?g6.I..1 _.L t_i a .__-.J X ...........R 31/-Cf.64,.4< -•CENSL1S TRACT .......................... Owner's Name ................................... ...........:. .:................P ....- - --. ...,. hone 2 S Address ............. .- ---------_--------- 7 ,. Contractor's Name ----- .................License i 3 !-/ - Phone . .._...._. Installation will serve: Residence RApartment House fl Commercial❑Trailer Court ❑ 9s 3 h Motel ❑Other •............ ......... Number of living units------------- Number of bedrooms 3 Garbage Grinder ^V.. Lot Size --•••-----•- Water Supply: Public System and name ..................-..........................................._..............................--•...............Private Character of soil to a depth of 3 feet- Sand IC Silt 0 Clay ❑ Peat❑ Sandy loam 0 Clay Loom❑ Hardpan 0 Adobe 0 Fill M6teriol ............ If yes,type............... ............._. (Plot plan, showing size of lot, location of system in relation to wells, 'buildings, etc. must be placed on reverse.,aide.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l t PACKAGE TREATMENT ( ] SEPTIC TANG f I Size----/_:r__0_10.........---................ Liquid Depth .mss.................. " Capacity JSD.0.------- Type . MaterialAACUk_._ No. Compartments +�� ---- Distance to nearest: Well .... ...._ ....Foundation . -- -: .... Prop. Line .:_<..S........... x 5 s LEACHING LINE I ] No. of Lines ... --- Length of each line.....` Q.... .. ...... Total Length -..*2'1.0.. ._ ,, .......----- tom. •D' Box ..-d�_.._ Type Filter Material-90.0.._.Depth,Filter .Materials..: ."T=I.:.=....:::::-' , • ,-��- Distance.to nearest: Well .!).AD Foundation wCz.�....... Property -Line ..�.�.... ... :..... EAGE PIT [ ) Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes [I Na i I Water Table Depth ...................... -Rock Size Distance to nearest: Well -----------•....................----.....foundation .................... Prop, line .--- .............. -1T P X REPAIR/ADDITION(Prev. Sanitation:Permit ..................................----•--------------------------------------- Date ----•-••----....--• � r 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 done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Hoare owner of Itcen- 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 as to becomesubject to Workman's Compensation laws of California." €, Signed . ..... .. .............. .•---------------._._ ...f.....----------------- -•---•--_ Owner /� ..J...QI�A. ...� `k�10L' itis BY .. -_.0 1 (If other than owner) FPJt DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE .. ,.- - -- r . BUILDING PERMIT ISSUED .-----DATE ----------------------------- -------"--- ADDITIONAL COMMENTS -------------' ,-..-----.... --••--------------&....._............. ----- ....................... ... final Inspection by: . -._.......... ....Date ...........:... f Eli 13 24 1-68 5�1 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/I4 3H