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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT lComplete in Triplicate). . _ Permit No. .. ..r a. rn ................. ------ This Permit Expires 1 Year From pate Issued Date issued r f 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: s JOB ADDRESS/LOCATIOi ..- 4© .__ ••-• • --_........................ CENSUS TRACT Owner's Name ..... baa' -Q'�dt�L.................. .............................• ...Phone� . ' Address ............. - i -�------•....... ... .............•- :.... ......_......----_...... City _..__......--•-------. ., _ Contractor's Name ----____r. ----.License # . �..�/ .. phone Installation will serve: Residence❑Apartment House 0 Commercial)r]Traller Court ❑ Motel ❑Other--------••-------•--•-- ..:. - Number of living units _.._ r a'� Y�� ____- Number of bedrooms ...__Garbage Grinder Lot Size /� Water Supply: Public System and name ......Private❑. - - ... ---------------------•_----------•---••-_ _ Character of soil too depth of 3 feet: Sand b. Silt❑ Gay [,) Peat o Sandy Loam 0 Clay Loam a Hardpan ❑ Adobe 0 Fill M6terial ............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 IINSTALLATION:_" [No septic tank or seepage pit permitteo-if,publie fewer is�availabfe witlifh 2OQ fiEt,) PACKAGE TREATMENT -.r +• ; , MENT ( ] SEPTIC TANK ] Size.- ...........:...... a- ... Liquid Depth Capacity ------ Material...................... No. Compartments � Distance to nearest: Well ;•______..__ - Foundation r LEACHING LINE P - u son -- o ire { No.loflines-,._._.:_.: . -•___-=length of each Elne . ` .`� f .W _ ..... Total -Length ................. 'D' Box ............ Type Filter_Material z Depth Filter Material . .... :. ..:. =µ. Distance to nearest: Well ----°.......----- Foundation ........................ Pro e r : ,r•- I p rty Line ....................... SEEPAGE PIT ( } Depot - :._---____-- Diameter �_�......._ Number .. ................. ...... Rock Filled Yes ❑ No Q Water Table'Depth ;- ....................... -.:.RotkSize II Distance to nearest: Well Foundation ................. ------ _... Prop. Lina .... - --------- REPAIR/ADDITION Prev. Sanitation!Permit f ( ............. Date .......... ---------------1 Septic Tank (Specify Requirements) ... r••• :•--•---•••---• Disposal Field (5lseci#y iteq.uirernents) -- -- V. �� i . ---•- --------------------------------------------------- Jr .................. •-..... ................ -------- 'r - - - ------- - ..................... .... ...... • •. {Draw existing and required�addit€on 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, aril Rules and Regulations of the..5an-Joaquin Local 1_Health,District. Hance owner or licen- sed agents signature Certifies the foliowing: "I certify that in the performance of the work for which thisermit is issued, ssued I shoji not employ P p y an y person in such manner as to become subject to Workman's Compensation .laws of California.,, � Signed --- By -------- --- --- -:.. I at r Owner Y . Title _...- _.... { t an ownerl F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... ......... .............. -------------------------------------- DATE.._. j BUILDING PERMIT ISSUED ------------------ - - •---- .__DATE -------------- ADDITIONAL COMMENTS --------------°----- �� t 4 x t - - final Inspection by: _.. ------------------••--------------------------------------- ----•--- ----.. -- ---- - -- -- -- - --•-•--......------..:.....-•-•-•---._....---•-- -• ---•--...---._.....-'.----._Date _... Eft 13 21� 1-68 Rev. 5�I - -- .- •................. SAN JOAQUIN LOCAL HEAITH DISTRICT 8/7h 3M