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E JK UNICE USE: ^— APPLICATION FO SnITATION PERMIT (Complete in Triplicate) Permit No. ..._....... ......... This Permit Expires 1 Year From Date issued Datta 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 County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATI N � , ,vim7,.� f)v aLlP . _... CENSUS TRACT _ Owner's Name ..._ ._-. ._f .-� l-'l.�s�. � �Q. ... ..Address .._• .. ...................Ph- .- 0... ' s one-7..._. ,:fir-�.c'.!�.. _ �.------• ._._... city .. ...I.�� Contractor's Name .._...------ f�� .....License # 1'� 'Phone Installation will serve: Residence J@ Apartment House fl CommercialTrail ❑ ler Court �] ' Motel [❑Other - Number of units: living .. ----_- Number of bedrooms A3.—Garbage i Garbage Grinder ............ Lot Size ._,f..�.�C.�.�.............. Supply: Public System and name "" ........... .. peat❑ Sandy loam - ..................__......._....... ...Private Character'of sail to a depth of 3 feet: Sand Sift j] Gla . • � ---.�-•�•�•��••_�•� JJ Clay Loam ❑ Hardpan 0 Adobe n Fill Material ............ If yes,type (Plot plan, showing size of lot, 19cation 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 j J SEPTIC TANK } Size . -- �`,X_._r�.__�-„J --.._. Liquid Depth . Capacity _I;L4 C3 Type • -- --.- Materiale 0 .. a. . Compartments p Distance to nearest: Well _...._.�..0. Foundation . 0. r •�----•---•-- - � ..- --�•--- Prop. Line .16......... � pe LEACHING ENE ----c�---- ------ Length of each line...-�--..s h ' [ ] No. of Lines _ .. _----. Total Length vw.-8...... --•_-• D' Box . ------ Type Filter Material c'.�-Depth .Filter Material . F..... � .� � --......................Distance to nearest: Weil _..._. ... --. Foundation ...�.� 1 #1 ............. Property Line .. . EP1F [ ! epth -------------- ---- i!" meter Numb ck Filled Y ❑ No 4] ! ter Table ; epth .......... ..............Ro Size ---------- Dista to'.neor : We#(- Foun ion { _...-----••-•- REPAIR/ADD(T(ON(Prev. Sanitation � .............. P. Date ..--•-----•..._....-----------•-••) Septic Tank )Specify .Requirements). -------............ =�: -------------------- Disposal Field (Specify Requirementsl ._-_-_e`.._ -------------------- ----------------------------------- ---•--••- --------•.•------••----•-----------•------- --------------•----•--------•-••-- . ----- ------ - ---------------------------------------- ---------------------------------- .......................... .................................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the\; vork will be clone in accordance with San Joaquin County Ordinances, State laws, and'Rules and Regulations of thi San Jomquin Local HeaI1h,0istdd. Home owner or liesn- sed agents signature certifies the following: I "t 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." i Signed ---- ------------- " --- ------•------- -------------- ------------- Owner BY - ---• . .- (If other than owner)....------ ------•------------- title . .._....... FO�DEPA�RTMEN�TUSE ONLY � APPLICATION ACCEPTED 8Y BUILDING PERMIT ISSUED - -- -------- - ----. DATE ADDITIONAL COMMENTS -- ---- .. DATE... ................. ...... --------- ..----- . t ---------- -----. final Ins. ection b - Y c =EH 13 2h 1-68 aev. -•=-------------------- ------- ---.............................Date d ._ SAN JOAQUIN LOCAL HEALTH DISTRICT ---------------------- ISTRICT 5 8/7h 3M