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�K u ce use: APPLICATION FOR SANITATION PERMIT Permit No. Z- (Complete in Triplicate) 7...1 �. . ................. ..... .......................... This Permit Expires i Year From Date Issued Date Issued ../..:2.:5:.7„7 Application is hereby made to the San Joaquin local Health,District for a permit to constrict and Install the work herein described. Thai application Is made in compliance with County Ordinance-No. 549 and existing Rules and Regulations JOB ADDRESS/LOCATION b.-.....:.. 5_a2.:... .............. �9, ��.r ..........................................CENSUS TRACT ....................... Owner's Name ........ i � .Y.................................. ..................... .......Phone Address .. . rim/1 .. s ..�l` �.... .A1, rG".�......................City ..........!/.......................... Contractor's Name -----4A.1 6;:1i�lS,,................. .............licansa# cr�.'i�l�� ca+ . Phone 6�)v --,Installation will serves Residence 0 Apartment House❑ Commercial❑Traller Court 0 Number of living units:_..-. Motel ❑Other...............::.....:...::.:.:.—----... * � f ng l.__. Number of bedrooms ...Garbage Grinder ............ Lot Size .1.. ��".1.� � Water Supply: Public System and name . .............................__........._.........._..........................................•••.......Private Character of soil to a depth of 3 feet- Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ day Loam Hardpan❑ Adobe p fill Mcterial ............If yes,type........................... 'Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed, an reverse side.) NEW INSTALLATION: 1 (No septic tank or seepage pit permitted If public'lewer Is available within 300 feet,! 08 PACKAGE TREATMENT [ ] SEPTIC TANK f } Size...66..X.Zk.. .?`.��............... liquid Depth .. .�................(k Capacirye ..... Type f Material...................... No Compartments ... .......... N .. Distance to nearest: Well rt:�........................�� .Foundation/40................ Prop. Line ....�............... �#ACHINGLINE { } No. of Linasl�! ��..� . Length of edid� �t .�...- :...�......Total Length ....................... 'D` Box ...r .. Type Filter Material /02,�Depth Filter Material ..../;?.��....................... - , Distance to nearest Well ........................ Foundation .......................:.Property lire ........................� SEEPAGE PIT [ [ Depth 7��............... Diameter ................ Number ........................ `:;Rock Filled Yes E3No ❑ Water Table Depth -•-•-- .................. .................Rock Size ............ ..._............... 40 Distance,tom nearest . : . Well .............. ... . .......... ...Foundation ...... .. .. ........ Prop. line ......... ........... o REPAIR/ADDITION{Prov. Sanitatin Permit# ............................................ Date .................................. y SepticTank (Specify Requirements) ......................................... ------•---................................................................._................ Disioosal Field (Specify Requirements) .............................................................. ..................................................:........ ...... .. -----------------•--.........................----••--•----•--••------------.......--•-••---........•--..._......................................................_......•-•-•-................... .. ............. -•-•--•-••-----••--•-•-••.........................................••----------- _................................................................................ (Draw existing and required addition an 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 Son Joaquin Lgcal.Health Olstrid. Home owner or licen• sed agents signature certifies the following- I "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 ubict to orkman's Compensation laws of California." Signed ` �.. .............. :............._. Owner By ..... .. ................................................. Jitle ..... . ......I....................... ..............._............. (If.other than ownerl DEPARTME T USE ONLY 7 APPLICATION ACCEPTED BY _ DACE'.. ,'•_ __ -...-.. / •.. . ... ... .. ....................-•--•.-- ....---..........-- _ BUILDING PERMIT ISSUED -^ - DATE-�..........-•............................... .......................I............................. I....._..._........-.... .__._.... .AD6ITIONAL COMMENTS--.. - ............ ....................._......-----..... - Final Inspection b =................." ......Date . ............. EH 13 21t 1'68.. Rev- cm., SAN AQUIN LOCAL HEALTH DISTRICT 8/7]t 314 r ��