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o- FOR OFFICE= USE: ' ... APPLICATION FOR SANITATION PERMIT (Complete in Triplicate► Permit No. ......_..._-...._ d ........ ... . This Permit Expires 1 Year From Date Issued Date lssued .6-7.7-3_._. 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, 544 and existing Rules and Regulations: Job ADDRESS/LOCATION ....... .-. - - ......... / �� . ._• a�rSU. . . ........... ......t15u5 Owner's Name ................. 4"-rte ............. �•r"�5'• /r ---•-•---•-•---•-----...._.---..__.Pltbrte AddressCA � .RL1ci tv Nf�I�rT..� ........................ Contractor's Nome .----..4'd ._. 7-elZ�Ex-------------•--------- -_ -------- ----.License # __VA7 d*... Phone 23� Installation will serve: Residence aApartment House Commercial❑Trailer Court ❑ Motel ❑Other.. - Number of living units ----- Number of bedrooms ..3------Garbage Grinder -•--•------- lot Sire ..1.'S-' .�-•-t- Water -------------• Water Supply: Public System and name ................• .....__...._._.... _ ------.Private IH Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cloy ❑ Peat❑ Sandy loam ❑ Cloy Loam 10 Hardpan [❑ Adobe ❑ Fill Material ......------ If yes,type ..................... . (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) U NEW INSTALLATION: (No septic tonk or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC TANK ............... --•• __--. Liquid Depth �. Capacity .J-12, v....--- Type .7?QFZM?� Material................. . No. Compartments -- Distance to nearest: Well .......... o ..Foundation /�.......__ > -- ••---•-•------•---- _-.... Prop. Line .--�-•--•-.......... LEACHING LINE [ j No, of Lines ... .- ---_.-. ' / Length of each Ifne......c :o._. :.•....... Total Length .....I_.F�9_......... '0,.Box .... ....... Type Filter Mbftrial /..l Y 1�Depth filter_Material-..:. ................ Distance to nearest: Well / � <1..---...... Fobnd&fvn .----------•-••-- Property Line ...tom. SEEPAGE PIT [ ] Depth Diameter Number Rork Filled Yea ❑ No ❑ ....... ...--•...................... Water Table Depth ........Rock Size -------------------------------- Distance to nearest: Well ........................................Foundation ... ...................- Prop.. Line ..... ................ REPAIR/ADDITION(Prev. Sanitation Permit# -------------•--- Date S Septic Tank (Specify Requirements) .................................. Disposal Field (.Specify Requirements) -- f ...........---------_----- ..............................- ----------------------------------------•---------- --•...................... (Draw existing and required addition on reverse side) I hereby certify that I havere ared this P p application and that the work win be stone lin accordance with San Joaquin County Ordinances, State Laws, and Rules and Ragulafiions *f the San Joaquin tem Heath 'District. Home owner or licew sed agents signature certifies the following: "I certify that in the perhwmance of the wadi for WMA Ibis penuit is issued, 1 sbm notemploy my � as to become subjec to Workman' Cam i in such ntgttner 1 pertsaYratt Ictus of California." Workman's r Signed ..:....,/�� . ..� �e By ......... ....:.. ....................---.-----•-•- .- ------------------------- Title . ...... -... ...................... ......... (If other than owner) -- 4 FOR DEPARTMENT USE ONLY; APPLICATION ACCEPTED- BY.. .Lt� __. _ = -- DATE _`._.. - ..__... BUILDING PERMIT ISSUED .:. ,----------------- ADDITIONAL COMMENTS .- ......_ _ - DATE .:• :.._...':: :_..?..... :.. ----------- --- --- _._. _ Final Inspection by. --- - - - -- - - Y_ - •--...._ -- -- Date - �;-/.3 .. ......... _ SAN JOAQUIN LOCAL HEALI}1 DISTRICT r E. H.1.3 24 1.'68 Rev. 5M 7 177 VM