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t'oR OFFICE USIA: APPLICATION POR SANITATION PERMIT ....................................................... (Complete in TrIpTlcots) Permit No. .7�...d.'�G ..................................... .............^ This Permit Expires I Year From Date Issued Date Tssue f` .`...,.... i ,........ - �. -7G I 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 ma_do In compliance with County Ordinance No. 549 and existing Rules and Regulatlonsr JOB ADDRESSAOCATION . .L ..- •+• �i4 ' !J- .............................CENSUS TRACT ............ . .. .. Owner's Name .d� . . .. ...........................r.....................................Phone ��_. �. .... Address .................... --------•- .....•---•---•--••--••-----•----_,.._... City �7 ... Contractor's Name F �.. , ..----_-_ .....................................License # Phone .&V3�r,�`, r' � Installation will serves esldencertment House❑ Commercial❑Trailer Court ❑ Motel[]Other Number of living units:--------____ Number of bedrooms 5......Garbage Grinder ............ Lot Slze ........................................... Water Supply, Public System and name .................................r....................—.__-._.............................................:Private Character of soil to a depth of 3 feet: , Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Loam❑ Hardpan❑ Adobe❑ Fill Material yes,type i (Piot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse stele.) i NEW INSTALLATIONS (No septic t k%K " e .pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] C ASize.. ............................................ Lictuld Depth .........._............... Capacity/,��lPe ..� �W '... Material--•................... No. Compartments ,2..w............. � Distance to nearest: We1i ..�ff......_.•................•Foundation ..__................. Prop. Line J- LEACHING LINE { ] No. of Lines -•- - _-:- Length of each line.�lr�..................... Totdl lengt ..,..............Ur 'D' Bax ._._.. Type Filter Materia! __....Depth filter Material ............................ Distance to nearest: Well op rty _- • . Foundation ........................ Pr a Lina .............,... - SEEPAGE IT { } Depth .................... Diameter ................ Number .. Rock Filled Yes ❑ No C�. k' Water Table Depth •-----------------•--. Rock Size•_. ...._..._ ...................... Distance to nearest: Well _... ...Foundation .................... Prop. Line r REPAIR ADDITION lProv. Sanitation Permit . Date 1 Septic Tank [Specify Requirem�ntsl ................. .......................... ............................................................�..._........._--.-_........... Disposal Field (Specify Requirements) ................................ ............................................................................................. ................................................. .__......... ...........--......................................................................................... ...:..................... ........................I............................ ................................................. .....------......_..._.... ._-...................._..... .... x (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the worts will be done In accordance with San Jeaquini County Ordinances, State Laws.)and Rules and Regulations of the San Joaquin Local Health District. Home owner or lican- sod 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 W orkma "s Compensation laws of California." Signed --- �jt . ... . ................ •-•-----•-------•-..........w---•-•-------_... Owner -•----- Zitle ................. (if other than owner) f FO&DtEP ENT US ONLY � ::: ,APPLICATION ACCEPTED BY .. .. ....... ... . .. ...................... DATE ... - ... i BUILDING PERMIT ISSUED ... DATE ........................................... ADDITIONAL MMEN,TS .. k .. _ s�� l;C,� ....foo 3�sr�..•_R .... ....... ...................... ..Date ........:,.. .. Final Inspection by: .. .. / . � .......................... Eft 13 2h 1-68 Rov. SAN JOAQUIN LOCAL HEALTH DISTRICT $I7h 3H