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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................................................... Permit No. .................... 1Completo In Triplicate) .................................................. Doti issued .3.:/-.7.---7... This Permit Expires 1 Year From Dale 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: /d r r JOB ADDRESS/LOCATION J..... l ..__... lne ��........................ Cl:N..... SUS TRACT ........................ ' Phone .................................... Owner's Name ..._._..... ee--.---•• .. . .... .j : Address ._'__........ !� - ------- Contractor's ----- ..:City _.... _ - -....._ .-.. .. . ... I �1 1License # .�1�3�- Phone�7••`.6 . . ��,� Contractors Name . V.11.--, �.. ----- ..................... .......... Installation will serve: Residence partment House C3 Comrnercidl oTrailer Court ❑ Motel ❑Other............... ........:..... ' ..... E ` 'Number of living units------ Number of bedrooms Garbage Grinder 1plce;r... lot Size _�...0 ~` ..........•...... 001 p Water Supply: Pubtic System and name ----------------------------------------------------1r._-...................................................Priva to Character of soil to a depth of 3 feet: Sand b Silt❑ Clay Peat.0 Sandy Loam ❑ Clay loam ❑" Hardpan ❑ Adobe W F1 I Material ............if yes,type ................ .::......... r- IPlot plan, showing size of lot,-location of system in relation to wells, "buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 244 feet) PACKAGE TREATMENT { ] SEPTIC_TANIC 1 I " Sire........... ......... ._.... Uquid Depth ................ •. - .. Capacity ---_- Type ' ..-- Material................ .. No. Compartments ......... Distance to nearest: Well ..................Foundation .............._....... Prop. Line ......._............_. l LEACHING LINE { ] No: of Lines ---- Length of each line............................ Total Length ...............•............. 'D' Box ............ Type Filter Material "" Depth Filter Material .....__._......... . Property Line Distance to nearest: Well ............€-------.... Foundation ........................ Prop . . ..,9 - M . , SEEPAGE PIT ( j Depth .................. Diameter ---.----..:. -. Number .............................. Rock Filled Yes ❑ No ] Water Table';Depth :..: = = = :Rack Size=-................................ ' Rto nea ll :-.---•.•.- _�....... ' Fouridatibri . P rop. Line ....................Distance EPAIR/ADDITION(Prey. Sanitation Petmit# ---••------ •---- ... ---.•---••... ---- Date ......•.................. ' ....... .Se tic Tank (Specify Requirementsj ------------- •� - '.. ......... I Disposal Field (Specify Requirements) i ,r - F ............. i ------------------------------------------_----------------------- --------------------.......---------.�................I............. _._..._ '.._:�.. -..__.. {Draw existing and required addition on.reverse.side) 1 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 Josieiuin Local Heallh:Dlstrlct. Home owner or 11con- sed agents signature certifies the following: r `� "I certify that in the performance of the work`-,for hich this permit is Issued, I shalt not employ any person In such manner as to become-subject to Workman's Compensation laws of California." l Signed ------------- -----• --= -- .......--------•�-•-•-------------...---- Owner 41 Title .... ..... �J I (if an owner) FOR DEPARTMENT USE ONLY o APPLICATION VCiPTED BY ---- A ------ • •--•-------- --._.. DATE ...��-f •-�Z.-. �� BUILDING PERMIT ISSUED --------------------------------------- ........ .. DAT€ ADDITIONAL COMMENTS :::..................• .. .'.-�._':._....._....:_..__....----•----- - ---------- ................ a S ------------_--------------------------------------_ ___________________________^-.__._...�.__......._..______. --- ....__-. _........__..____.....___.._._._... .-______-._.. __ w. __. .. _ ------ :: �. Final Inspection by: _.__._..... ............... � t Date _. _.._... EH 13 2}t 1-68 - i�rr. � N GAL ALTH DISTRICT 874 3M 5Y''1 SAN J4AQUI LO