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FOR OFFICE USE- APPLICATION FOR SANITATION PERMIT .......... ......•--------.. ......... -- (Complete in Triplicate) Permit No. ..7..---_ --.. ...................•..__.._... ..... ... .... `S 7S This Permit Expires I Year From Date Issued Date Issued ................. Application is hereby made to the San Joaquin focal 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: JOB ADDRESS/LOCATIONl DI .� ---- - A�-•�^ ►.......................................CENSUS TRACT ....I——._............. Owner's Name tea: -................................... ......---Phone ...-- f/ ..... ..... Address �_ ._ lA. ........ City .. .. _. ............................•---_._ ........_ Contractor's Name ,t?!ff�ta.Q-. .:... _ , F�"`� ... ...----.license # .A .dv.3k?!7n. Phone .............................. Installation will serve: Residence ❑Apartment House❑ Commercial 0fraller Court Motel ❑Other _ * ................... Number of living units............. Number of bedrooms ............Garbage Grinder ............ Lot Size ...........................................{ A Water Supply: Public System and name -•---•---•.........................•---••-=......-=----------..........................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam e Clay loam ❑ Hardpan ❑ Adobe❑ fill Material ............ If yes,type ............... ............ \ (Plot pion, showing ize of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATIOI�Q: (No septic tank or see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ Size_.7.1 �(.�1X.'r ..... Liquid Depth ....`�. ............. Capacity _ . a ------- Type �ra--- Material-----ir No. Compartments -- ............. Distance to nearest: Well --------- p7fl .............Foundation..__,ld ...... Prop. Line __---.� ...... LEACHING LINE No. of Lines ........!.............. Length of each line...... Q .......... Total Length .6p ........:...... 'D' Box ....77!77:-- Type filter Material ...._�R,.......Depth Filter Material ...1.9..` ........ ................. Distance to nearest: Well _.......-fir®_ Foundation Property line .... ......... SEEPAGE PIT ( Depth ------A�A.. Diameter ....... Number ..........I............... Rock Filled Yes [" No i❑ Water Table Depth .................2Ait,----------------------Rock Size Distance to nearest: Well ---------- _ .Foundation ..-Q--14.` ..... Prop. Line - ...... REPAIR/ADDITION(Prev. Sanitation Permit# ---.----.---.------------------------------- Date .................................. SepticTank (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. Nome owner or Iicen. sed agents signature certifies the followings "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 become subject to Workman's Compensation laws of California." Signed ---- -------- ---------------------------- ----------------- -------------- Owner Sitlek � (If other than owner) FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY __---..._. - -.- ..--------------- ------------•--•----•-••-- -- -...-----:-------..,..-----------.. DATE ...�`---------...- --.------:::.....: BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------- ----••-- --.... •----..._-DATE ------ ......_.._...._....._.....---•---- ADDITIONAL COMMENTS --------------------- ---- ---------------------------------------------------- ------------------------------------------------------_ ----------- -•---- --------------------------------•-------..--------- -------------------------------------- --- $------.....__. Final Inspection b �.. . p y: ..---•-------�-------- ------------------------------------------------------------------•---•-------...--•-•---...._Date .................--------- ..._......... -- EH 13 2h 1-68 ffev. SM SAN JOAQUIN LOCAL- HEALTH DISTRICT 8/7h 3M