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FOR OFFICE USE: % - APPLICATION FOR SANITATION- PERMIT -_ .�... �r�--- • '� Permit No. . .: .,c.......-•-• 3 U_.... U�f .,, IConrplete.in Triplicate) _... °... .. Date"Issued -/U 7G ............................:.... T 'it Permltfxpires t Year i:rarn".Dahlssued >` -----•• Application is hereby made to the San Joaquin Local Health District for 6 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 `--� _�...xz �O.�J f- y ` .._ ........... CENSUS TRACT ................:......... Owner's Name •---_... ....... ,R. phone ................ Address :. �s l--�� .P.�.. = ... t rCity ....__.... ................ a 1r � Contractor's Name y .....��..........................f.-.License 1-., � .. Ph on e .�Z�`4 e .. Installation will serve: Residence Appaartment Houseo Commercial OTroller Court I❑Other ` 9 Motel ....... :............. Number of living units.---./-.... Number df bedrooms n .., --...Garbage 'Grinder Water Supply: Public System and name�.-, 1:/-...__ Tr.. , (e./ . �............... ...... . .Private 0 , Character of soil to a depth of 3 feet: Sand 0 Silt'o Clay Q Peat Q Sandy Loam [j Clay LoamC] Hardpan 0 Adobe-IN Fill M6ferial ............if , tyP es e Y ............... ....... IPlot plan, showing size of lot, location of system'In-,reldNonrto wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic,tan i rqs epage pit;permitted it public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK "� ,{._1-;,... � '"Sizer-•-•......................................•--- Liquid 'Depth ..........................lS� , Capacity-- •=-----•---•--•----- Type -------------------- Material-------•-------------- No. Compartments ..:............... •. fr LEACH Distance to .nearest: Well Foundation I ' �F LEACHING LINE j } No. of tines ........................ Length of each line.__._...---.----_-- •.-- Total*-'Length. .-- .` 'D' Box r"7 Type Filter Material Depth .Filter MaterialR. ....-- --.--•-• '.� Distance to neatrest: Well ........................ Foundation ..........._ p �y __...._..... Pro a Line ........................ SEEPAGE:PIT p Rock Filled Yea No I ) De th'- :_._:: :-Dicxmeter--- _----- .... Number .............:........... Q . r Water Table Depth - .Rock Size ._ f f , Distance to nearest: Well 1 -.Foundation Prop. Line ...................... REPAIR/AbDITiONSanitation Permit# Date Y (Prev.I ........................ ......._.._..................1.. ` Septic Tank (Specify Requirements)............ Disposal Field (Specify Requirements) ...... . !�...-� s / _G 7 :� 3 �C . '----------------- .......................... ------•---•---•--- (Draw existing and required addition on reverse side) I .hereby certify that 1 have prepared this application and that the work will be dons in"`4ccordance' with San Joaquin County Ordinances, Statedaws,.and'-Ruies-and_Regulations'af the San Joaquin Local Health.District. Horne owner or licen- sed agents signature certifies the following: terrify 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 .... rOwner ��^ BY . Title _. . � other than owned ( s It DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -------------..........................`-•--...__..._.-- -------- -. BUILDING PERMIT ISSUED __---- ----- DATE '- --_......___--: - --- ----•--------------•--------._...:.-._..------�--.....---......:. :._....:.____ .DATE _._........_._......,:----. ..-. - ADDITIONAL COMMENTS ----- - ------ -- ' .............. - ..._............................. .......---- -- Final inspection by: =• •_... ... -- f .................... - -- -• - �---- ------------------•----..:,..._...-...--------..._..�..------•--..__Dore�.".�'... .- I EH 13 .21 1-68 Fb— �f --------------------- SAN JOAQUIN LOCAL IiEALTH DISTRICT 8/71; 31,q a