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FOR OFFICE USE: 4 APPLICATION FOR SANITATION PERMIT ]! Fec 1... Permit No. ... .---•----- (Complete in Triplicate( _ :X- _ /. ...- . p �. = -j 7 ..........I.................-•---•••. ------ •--..- .•-_-.... This Permit Expires 1 Year from Date, 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 compliance with Co Y-Orglinance No 549 and existing Rules and Regulations: ' JOB ADDRESS/LOCATION .. :.r_...........................CENSUS TRACT ..............I........... Owner's Name ............ ............ ©c.............Phone ................ '.. Address..-------••...... .............•-- ---•--.....:City .., - .. ............ Contractor's Name ... _ -_. c� . _. ��.., License �l` . 3�f?--3.-. Phone ...f�•�•G �' o Installation will serve: Residence Apartment House Commercial❑Trailer Court 0 Motel ❑Other................... Number of living units:---!----- Number�of bedrooms -1....... Grinder ............ Lot Size ... • .......... Water Supply: Public System and name .............................................__...................................................... :.....Priya#e Character of soil to a depth of 3 feet . Sand,)] Silt Q Clay ❑ Peat© Sandy Loom ❑ Clay Loam Q ;. 'Hardpan[} Adobe Fill Mcterial if yes,type . •`'r (Plot plan, showing size of lot, location. of system in relations 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 [I SEPTIC TANK{ I Size-......._---�j ---7....._.......... Liquid Depth .....JZ............ Capacity ---/2ta_U.... Type PM_4j&t. Material---S�e.V_---_--._ No. Compartments .....:. ...._ Distance to nearest: Well .jam ..................Foundation Prop:Line ......... LEACHING LINE[ ] No. of Lines ----:-- r__.__----- Length of each line........ ........... Total Length ._-� � ._ ...---• 'D" Box ?_... Type filter Material .1.:-X.)V_:_Depth .Filter Material ....,� ..r............................ Distance to nearest: Well _4W............... Foundation .../Q---..-......... Proi: rti4lne ••••••••• SEEPAGE PIT [ 3 Depth __11 .._.... Diameter .33---...... Number .---_- ----------------- Rock Filled Yes)K No i❑ tr __..Rock Size ............ I Water Table Depth L_,---d,S:........ , . _ _ Distance to nearest: -•----••- -._---_Foundation /0..'f-••---. Prop. Line . - ---...... . � REPAIR/ADDITION(Prev. Sanitation Permit a _.__------------------------------• - `'•Date .-__ =-.--•---) Septic Tank (Specify Requirements). --;•• 4 Disposal Field (Specify Requirements) w:..--.._. --- ------------------------------- -------------------------- -••---.... --------------------- ------------ ------------.._ ................ - ------------------------------------------ ................--------- --......... .............. �.... (Draw existing and required addition on reverse side) �I hereby certify that 1 have prepared this application and,that the work will be done in accordance with San. Joaquin County Ordinances, State Laws, aridRules and Regulations of the San Joaquin Local Health:District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this:permit is issued, l shall. not employ any parson.in such manner i as to beco subject #o Workman' Compensation laws of California." Signed _ .. - ,,� ................ Owner 07� r �,w By -----'---- :.. >..... - - ---------if-- Title . - ........................ ...... �� 4��-•�{If other ha._ caner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_� :.Vw. __ = -- ----------------------Z---- ---------------_-------------------------- � ..�.-:..--.-..._.... BUILDING PERMIT•ISSUED _ ----- ------ ------ -----._ • - - - - ----------•-•-----.............•------------------------------------DATE ....-............................ ..--.-.... ADDITIONALCOMMENTS -----------------------------------------------------------------------------------------------------------------------------------...--.............---.-•-•.. : : :.. ::: � :- - - - -- - - :::::::::::: ::: :: ------:::::: ... -------- --....- - �--------------•----------....-. . .. .----.------ - -------------D_ ---.. ate .- -'- ........final Inspection by: - ---------------------------------------•------•••- .... EH 13 24 1-68 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M