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FOR OFFICE USE: - u APPLICATION FOR SANITATION PERMIT ............•..... .................................... (Complete In Trlplicato) Permit No. .. :5._, :3 �3-/_ ......................................................... This Permit Expires l Year Front Date Issued / S Dote Issued Application Is hereby made to the Son 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. SA9 anq existing Rules and Regulatlonst JOB ADDRESS/IOCATf l .�lZ�... .. �rtt.f�t'�. y V.._.... . . >`lR�urs ....... CENSUS TRACT Owner's Nome c�. .. .. .............. ............... ................Phone .................................... Address _..,J�'� a�....., y - �4.K,i.. . .....................City . . ...... .... -.::.........._ ...... :. Contractor's Name ..... ..... ... . ..... .... .... ... -----.License Phone .......................... Installation Installation will server Residence❑Apartment HouseQ�mmerclal❑Troller Court C) 1 Motel[]Other .-- ..........: Number of living units:_ n-- Number of bedrooms ___Garbage Grinder .....—.— Lot Size ...........___ r. j Water Supply: Public System and name __________________________._.....................—.................-------•-_------ •---•--•--..Private{� Character of soil to'a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Er---- S; I , Hardpan❑ Adobe❑ Fill Material ............ If yes,type ............... ............ } f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.t NEW INSTALLATIONt INo septic tank or see age pit permitted if public sewer is available within 200 feet,) �y, PACKAGE TREATMENT [ ] SEPTIC TANK Liquid Depth __..T._ ...:.....r Capacity 0..... Type 1Material---{�T�^�.�_. No. Compartments ---7=....... 4-' Distance to nearest: Well �-�0...............Foundation ..... Ll Prop. Line —1 LEACHING LINE [ No. of Lines .......c ........... Length of each line....... .5 ._.. Total Length .....1 ar i 'D' Box ...../.... Type Filter Material ........5..ek....Depth FilterMaterial _--.-/.,(...',!......................... Distance to nearest: Well SP Foundations ... Property Line .:� ...... • ..... .. ' ,/ op rty ( ... ['fl p ......... Number a;1.._....... Rock Filled Yes No SEEPAGE PIT Depth .._..v�__... Diameter ._. Water Table Depth 141 ...Rock Size........ f.1. .111/3 _/__ ......... Distance to nearest: Well .... 5YY.................Foundation ........11-eprop. Line .... _r REPAIR/ADDITION(Prev. Sanitation Permit#-____--_-___---------------•---------------- Date ............. .............. Septic Tank (Specify Requirements) ......................................... -----___.._.......__. . ._......: .._...... .�_ ......._................... Disposal Field (Specify Requirements) --------------------- - .....-.....................•--..........---...---........_..---•-----..............-----------•--•--._......_..._....-.._.....--•-• ------............................................................... (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 Joaquin Local Health District. Horne owner or licen- sed agents signature certifies the following: "I certify 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 ................................... ....._ ...._............... ._..........._....._ Owner By ..........................................L. / �......_.. 3ifle .. ... .. �'' .... (If other than owner) FOR DEPARTMENT USE ONLY .. .. r:.....:.::': .:. APPLICATION ACCEPTED BY _4 . _ _ DATE ..wr: -•�.:.: ..... ' BUILDINGPERMIT ISSUED ......:..........................................................................................:........DATE . ........................................ ADDITIONAL COMMENTS ....................... •-•--...•----................ ................................................. --••-.. .............••-...._..........._...._.....-.. -......................................................................................................... ..................... ...................----...... Final Inspection 6y: _...._ ....._ ...................I............................Dote .....` ,..'!.k .......... EH 13 2h 1'68 Rev. -f SAN JOAQUIN LOCAL HEALTH DISTRICT $/71, 3M I S