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FOR OFFICE USE: , APPLICAri%-,4 ICOR SANITATION PERMIT ` (Complete in Triplicate) Permit No. .T�......_..... ........ ......... :. __. ... .._�_ _. . _.,.. _ .. 5 ..... .. L. iDate issued ... This Permit Expires 1 Year from Dote 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 Ordina N , 549 and existing Rules and Regulations: I J08 ADDRESS/LOCATION �` � � ........� ... ?.� .-- ._.. . .�.. ..... ..... ..... . ................CENSUS TRACT ................ ........ Owner's Name .. .._ ........ �,4P'...: ..,.::.._. -., one Address City Contractor's Name .. ...License 411' ............. Phone Installation will serve: Residence Apartment House f3 Commercial[3'Troiler Court 0 / Motel ❑Other...... ..:.... :..:.. Number of living units:..!...-- Number of bedrooms .....Garbage Grinder ...-...:.... Lot Size .. -- + -'6 Water Supply: Public System and name : .. �.�'".. ................. -- -�. -.... . ----- ......................Private Character of soil to a depth of 3 feet: Sand 0 Silt[3 Cloy tg peat 0 Sandy Loam 0 ClayLoam Hardpan[) Adobeo Fill Material ............if yes type............ I.......... (Plot plan, showing size of 'lot, location of system: in rotation tor wells, buildings, etc. must be placed on reverse side.) NJ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANS .............: ....__. Liquid Depth ___-•- Capacity/ ........ Type :. . Material-_C4>.'?' -;--- No. Compartments ...'? ......... Distance.to nearest: Well —>Z-V.... ....................Foundation ............ Prop. Line.. ................ i ti. LEACHING LINE ,[ No. of Lines . . Length of each iine.Ar................ Total Length ............ ' 'D' Box R-tw.:. Type Filter Material ./a-! ........Depth .Filter Material _.1 ............................... i ..... Foundation ....... Property ProertLine f Distance to nearest: Well .. .. •-•..................... SEEPAGE, PIT Depth i�7 .-- ---. Diameter 3 .��.:..._. Number ........ ----=,---.• .. .. R k Filled Yes No i0 Water Table Depth -.??------------------------ --•---•------.Ro Size _ --••-- ---- - --- •• • - •- Distance to nearest: Well --- .Fou Prop. Line ....... ... . -- ................ - REPAIR/ADDITION(Prev. Sanitation Permit# ...:.......:...........••- ----------------- owe ............................,...... " Septic Tank (Specify Requirements. ................ - ......................................................... "Disposal .Field (Specify Requirements) ............... � -- _..... ................ .. ---------- ------ -----------•--- ::.� =,�r . _ .. _ .,� .._... -•---- •-----••. • •---------•.................. .•... ----------------- ......... ----------------------- ---•----------------------••- ----- - ..-•--•--•-•------...... (Draw existing and required addition on reVerse side) . 1 :hereby certify that I have prepared this application and that the work milli be done in accordance.with San Jear;V 4 County Ordinances, State Laws, anal Rules and Regulations of the 'San Joaquin Local Health:District. Hance owner or !leen. sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is Issued, I shalt not employ any person in such manner as to become s bleat to Workman's Co pensation .laws of California." Signed . _ .. t --------- -------- -• Owner By ..__..... ---------------- --- --•-- . 'itle . (If other than owner! _ FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY ..........................:. .......... ._. ...,.DAT.E_ s�� .. ............. - BUILDING PERMIT ISSUED // Ir� v ,..--.._ ............... DATE ADDITIONAL COMMENTS .- ;A,4 -- ------��.� _r.,-.._ - • ---•-: � -- �----- '�...-................� --•- ---...... M -1 _ _. -..............- --- __________ __ .-._..-..K_.-.... -........._.._..Final Inspection by: . •-•---..._.......... ----• ...... -----...................�...............•--............._..._......_...Date ..�.... .. .: EH 13 2� 1-68 Rev. 5m SAN JOAQUIN LQsrAL !-HEALTH DISTRICT 8/7h 3M