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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . :...............•---•---...------------..._ 7�-_fie•-•�, (Complete in Triplicate) Permit No, ._... el 3-, S .. ... This Permit Expires I Year From Date Issued Date 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/LOCATN ..e� �., ...._..�. .. ..-----•-----•-- -••.2-w ........................ .........................C'NPShUaS eTRACT ....,..................... ........... . .............. ........Owner's Name Address ... ...._.-ter" .:2. _.__...�� s........_s' .C...._. City .._.... —� . ....••.•.--- Contractor's Name s:--- 4-�,:: ...... ----- ------ ------•-- �..---._.License # Phone Installation will serve: Residence [Apartment House fj Commercial❑Trailer Court 0 Motel ❑Other ........... :. Number of living units:------ Number of bedrooms Garbe a Grinder ............ Lot Size 1 Water Supply: Public System and name .........................................................-.................... ................................Private f Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [:] Peot.❑ —Sandy-Loom ❑-- Clay Loam f-1Hardpan j / Adobe 0 Fill Material ............ If yes,type k (Plot plan, showing size of lot, location of system in relation to wefts, -buildings, etc. must be placed on reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is avoiloble within 200 feet,) 1 PACKAGE TREATMENT [ ]. SEPTIC TANK I ] Size.................................. .............z� Liquid Depth ......................... Capacity --- Type -------------------- Material.....---------'-..._-- No. Compartments ..---................ - Distance to nearest: Wel) ------------------------•-•-•-__- Foundation'. _._..-.--------.- Prop. Line ............."........�./ LEACHING LINE [ ] No. of tines ............._-------- Length of each line............__--------i..... Total length ...._..____...._.._ ....... 'D' Box .......... Type Filter Material ....................Depth Fitter Material ...------ --•--------•------•.•_--- Distance to nearest: Weft •----------------------- Foundation --- .................... Property Line ......................... SEEPAGE PIT [ J Del-th -------------------- Diameter ------..__--.. Number ----------.._.__-.._- ---- Rock Filled Yes [3 No �} Water Table Depth -•---------- ...................... - -----Rock Size ................................ �1 lDistance to nearest: Well ............................:..::.......Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit;# --------.----•----------------------- Date ......._..................,....... ] fSeptic Tank (Specify Requirements) --------------------------------- ------------- ----------------------------- ............................................................. Dia) Field (Specify Requirements) . `-. -' `........................".... o IJ _:`__. c -o`"`c�� ! 3 f--�•�---- - ....--•--------•...._ ..................•--------------.....-- -••---•--•---•-• Y " (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 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 •---- -------------------------------------- -- --� _-. - - Title (if other than owner) . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- u-.-y__.___ ._ S .,�_�-- 'S- --- - - ---......---•-•...... ........... DATE 7 ...------. BUILDING PERMIT ISSUED ------------- DATE --------------------- ....... ADDITIONAL COMMENTS ----------- G��'��C ---------------•-----•---••---------•--------------------------•---•-------------- -----------..................... --------•- --•----- ------------------_-----•-•----- - Final Inspection b ... .........� ..�- .... _..,r-,S...-----•---- E#i 13 2la 1-68 idev. jM SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M _ "�✓ r