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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT37� Permit'No. -------------- ........... ........... ........ (Complete in Triplicate) ........................:................................ Date issued ................................................ This Permit Expires 1 Year From Date Issued Appiication'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: JOB ADDRESS/LOCATION - fir - -- •.: ` ......... :.CENSUS TRACT ......... .....t`._ Owner's Name ............................. ........Phone/A;�. ..�- ... �v ...............••................ f. . C€tyAddress ............ _ h Contractor's Name .__ .......-.License# ---......... __. Phone 9 Q Installation will serve: Residence Apartment House❑ Commercial ❑Traller Court [ Motel ❑Other ............................. . Number of bedrooms ---, r...Garage Grinder -__.•_...... Lot Size ••••••-• Number of living units:.._.--_. bGi - , . Water Supply: Public System and name ..................................... -------_--------.--�......................... Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ =Peat❑ Sand Loam Cla Loam II ;.Hardpan Q Adobe Fill Material -...........If yes,type ............... !Plot plan, showing size of fol, location of system In-relation to wells, buildings, etc. must 6e plated an reverse side.) I NEW INSTALLATION: (No septic tank or seepage pit,permltted if'public sewer is available within 200 feet,) i PACKAGE TREATMENT [ ] SEPTIC TANK I ] _ . Size.....:..................... � Liquid Depth .................... *' ---- Material................ .. No. Compartments Capacity --t-----------•- ................ Distance to nearest- Well- -------.}• Foundation ...-_.it Prop. Line ...................... r x Ic LEACHING LINE I ] --------------- ----- Len th of each line..._-------..--.. ... Total Lengt ._.._.......---..._......... No. of Lutes � 8 ""-'-' -D' Box . -- Type filter Material ...•................Depth Filter Material ..... ....................•-.............. Distance to nearest: Well ...--- •----•--•---•--- Foundation ........ .._............... Property Line ._...................... SEEPAGE PIT f l Depth .-- `-------------- Diameter ................. Number .______---...... No ❑.------•..._. Rock filled Yes ❑ T I �Water Table Depth -. � ........-Rock Size ...........................•--... i . t .:Foundation ... Prop. Line Distance to nearest: Well .. REPAIR/ADDITION(Prev. Sonitotion Permit# _ ----•--•--------------------- Date .--------•-•----...._..:•-•----•-�--.....----..........--- i Septic Tank (Specify requirements) �� - -' _... __._-- °--- ---•- S • Disposal Fi (Specify R quirements) '�` ` E - ` "�' --------- ......Z�. - . f ------------------------------- .---------------.--------------------------.....:-----..._..._-........__............--.._....:...............-....__......_-_._ (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 Jaaquin Local Health:District. Home owner or licen- sed agents signature certifies the following- "I ollowing: person in such manner " I:certify that in the performance of the work for which this permit is issued, i shall not employ any p as to become sub[~ect to Wor an's Compensat n laws (Tf�' of.....aliforn im0. Signed ---------- ------- ...... er /�. f N 7itie ....................... -.t-•-- BY ----- ---------- -------- r- n- - (If other than ovrinerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = --.... DATE - ..-,-�-.-. - ----- .... BUILDING PERMIT ISSUED -.--. . ................................. ... .... DATE - ADDITIONAt_ COMMENTS -------------------------------- ............ ------ ...... I --------....................... _ "..-..- -- --•--.........-•----------=-- - i -----. ---- -- ..-.. - Final Inspection b Date ...._ ' EH 13 24 1•-68 He SAN JCAQtXfl LOCAL HEALTH DISTRICT 8/7h 3M CGSi r '