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FOR OFFICE USEs APPLICATION FOR SANITATION PERMIT ............. .............,...................... Permit No. .X:K 7.V... (Complete In Triplicate) . ............................................ g- .� Date issued This Permit Expires 9 Year From Date Issued 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 co 11ance with County Ordinance No. 549 and existing Rules and Regulotlonsi .S! pp ...........CENSUS TRACT ................. .. JOB ADDRESS/LOCATIO ......�Ll.... ................ ..... .. .................. Owner's Name .._ . ---........ ... .. ..... Phone .".� .... r• <kddress ............... ... .......__.. .:: . _ .. City .......................... ..............I........ Contractor's Name .4 License slE '� . Phone `.'�' .- ��.�•-...- --- ..... --- . ... ........................ -......_.... installation will serves Residence XApartment House Commercial QTrailer Court Q Motel Q Other Number of living units:... Numiiirer of bedroom$ ----........Garbage Grinder ............ Lot Size .................... .. . .......-4. Water Supply, Public System and name . ------------•---.-.-.--•--...-._--------------------_._..._._........._......._......_.................Private Character of soil to a depth of 3 feet: Sand Q Silt Q Clay Q Peat❑ Sandy Loam 0 Clay Loam Hardpan❑ Adobe 0Fill Material ............ If yes,type.......... �......... tPiot 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,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth .................J Capacity .... T Material....................... No. Compartments s • Distance to nearest: Well ... Foundation .... Prop. Line'EACHING LINE O No. of Lines ........................ Length of each`lini.... ...Y................ Total Length D' Box Type Filter Material ....................Depth Filter Materlol ...................................Distance to nearesh Well ......................... Foundation .......I................. Property Line ............... SEEPAGE PIT [ I Depth .................... Diameter .........._..... Number ............................ Rock Filled Yes Q No Q A. Water Table Depth ................................................Rock Size ............."_w. ............. Distance to nearest: Well foundation Prop. line REPAIR/ADDITION(Prev. Sanitation Permit# ...... ..................................... Date ..................................I Septic Tank (Specify Requirement$) ... - --- -• ...........:.........................................._................ ... ::. .:......................... .. Dis�nosal Fiela pecify Requirements) -- ••- ""..... .--------.---.----•-.....---- . ....._ (Draw existing and required addition on reverse sldeV 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 Sari Joaquin local Health District.Horne owner or titan- ' " sed agents signature certifies the following: ► "I certify that In the performance of the worts for which this permit is issued, I shall not employ any person in such manner, as to become subject o Workman' Compe satlon laws f California." �neC 7_S.W�_. .. �= ._ ..... .... BYVrter By Cr`� _ Jitle t �/ ..... ......................."._.-.:_......_._......_._....._..._. .---_. ------------- 4 (if other than owner) v :. , FOR DEPARTMENT USE ONLY a-� ................................... DATE ..:. APPLICATION ACCEPTED BY �} "'- - d� ';' BUILDING PERMIT ISSUED r .DATE.......................................... ..................................I......... ... ADDITIONAL COMMENTS .... .........................---........ ..-. _. _ ......................................._....... .. ........... __ ..:..........::. ......... Final Inspection b .. . --•-- -- ...-- .........Date ... . ... .-•-- -,,r._.. :..... . .:..... Fri 13 24 1-68 Re • -qf SAN JO QUIN LOCAL HEALTH DISTRICT 8/7h 3M