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r%JA Wr l" Wt: APPLICATION FOR SANITATION PERMIT �y ............. %.41................................ '(C0i pis,1e in T'ripllcaNf Permit No. . ............. . ................... r This PerrnlAxpires I Year From Date issued Date Issued .. Application is hereby made to the San Joaquin Local Health District for a permit to constrict and install the work Mersin described. This application Is made In compliance with County Ordinance No. 549 and existing Ruler and Regulatlons: JOB ADDRESSAOCATION .. ,c _ . ..... ?..................................................CENSUS TRACT .......................... Owner's Name ... � .. fir ! - .............................. ............ Phone Address ......�� Q ../.lir. Z �'�?�_....`... ......................City .... .�..................... ................... Contractor': Name .....� r . : ._... .,. ' .:.................License # 7� �1_._. Phone .�.�2 :.. Installation will serve: Residence J$Apartment House❑ Commercial❑Traller Court 0 Motel ❑Other............................................ , Number of living units:_._../... Number of bq4ropms ... _. ..Garbage Grinder _-•------- Lot Size ... ....... Water SvPpIY= Public System and name ...............—.......-..........................................Private❑ Character of soil to a depth of 3 feet= Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom/Rf Clay loom Q Hardpan(3 Adobe❑ Fill Materlal ............If yet,type ............... ............ (Plot plan, showing sire of lot, location of system In relation 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 [ ] SEPTIC TANK€ ] Size.... Q... .............. Liquid Depth .......................... Capacity 14 ....... Type 54 . Materia ... �?� No. Compartments ..Or.2 ......... Distance to nearest= Well- ---- 1e..11, ...Foundation ..... ._... .. 11...... Prop. Ltnq -..... LEACHING LINE [ ] No. of Lines .--/................ Langth of each I ne.' !-'- Total Length 'D' Box .._...1.... Type Filter Material,. .xcr2- .Depth Filter Material ------ ................-.........._.. Distance to nearest: Well ....WX. �...... Foundation ...... .. ............ Property Line ./:�.................�1 SEEPAGE PIT [ [ Depth ..........:...4.... Diameter ................ Number ---•------------------._.--- hock Filled Yes ❑ No ❑� Water Table Depth ................................................Rock Size ............................. Distance to nearest: Well ............................I Foundation oundation ...... Prop. Line .. .............. REPAIR/ADDITION(Prev. Sanitation Permit .................................... )Date ...............................--. Septic Tank (Specify Requirements) .... .........•----... `. . ....-.._...............................................................-............... .9 DisposalField (Specify Requirements) ...................................... .............................................................................................. 't r .....................--•--•.............................---•------•••-----••......---....................•---...................................-..........----......••----......------.................. (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 Joaquin Local Health District. Home awns* or Ilcen- sed agents signature certifies the following- "I certify that In the performance of the work for which this permit is Issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ....... . .............I............. Owner By ... . Z. .... ................................. ....Title :... ._- .. ,........................----.... pf other th n own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 80\A .. DATE ...... 1 BUILDING PERMIT ISSUED . ......................................DATE ...._.......................... ........ ADDITIONAL. COMMENTS --- " :._.. ............ ............ ........................................... . ................... Final Inspection Lay: :bate ._.... .,... lH 13 2!t 1-68 5 SAN JOAQUIN LOCAL"HEALTH DISTRICT 8/7h 3M