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FOR OFFICE U5l: APPLICATION FOR SANITATION PERMIT _. ........ pTriplicate) Permit No. ... �- � - L ' T (Coni fete in _ i This Permit Expires t 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/LOCATION. .. �l.. __.Lo,►... .......:.............................CENSUS TRACT .................. Owner's Name _....// u} ................. :....:..............._Pho /.. �— Address -------------_------- jo . ......_ ..._....--- ---•-- - -..........----.... CitY ------..........._...,.....................-----------..... •--- �61v Contractor's Name .. ,Q�. ........ ............... License # .........: ............ Phone ........ .- r- - Installation will serve. Residence G5Apartment House{] Commercial❑Traller Court �] Motel ❑Other Number of living units;.... Number of bedrooms ..]......--Garbage Grinder --------- Lot Size ... Water Supply: Public System and name ..................................._----•-....----:....._.-,----..........-----............................Private Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan[j Adobe g^ Fill Material ............ If yes,type............... ............ (Plot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK iza.......•--.. .. _--�- ........................ Liquid Depth ...pyo... -��,---•- s . . p ty! 2+e-0 Type r1�-- -� �Moterial. -� No. Compartments -,--.Z—.....--_ X11 Distanceito nearest: Well ---- - -` ----•......Foundation -_..... Prop. Line -•__-•• -•- . a . LEACHING LINE [}q No. of Lines k--- -- Length of each line...... Total length ....... D' Box t Type Filter Material ... ..Depth Filter Material .. i _ � a Distance to nearest. Weation ........... Property ..__1��...- ...... SEEPAGE PIT Depth e e- biameter .....:�- ----- Number ............ .. Rac Filled Yes No (3 a Water Fable Depth _..__-D.,C_ .,74..`:....................Rock Size Distance to nearest: Well ......�_��_._._...............Foundation ._......:.......... Prop. Line ..................... I REPAIR/ADDITION IPrev. Sanitation Permit# .................•.---........----••---•-•-- Date .................................. ,i - Septic Tank (Specify Requirements) --------•-------------------•--•--••-------•----•-•.....................-.........._.......=•----.... Disposal Field (Specify Requirements) --------•---- - ------------ ............... ................. ............................ -------------------------------------- -----•----•-------------•-•---••--••--•--------•------•--•. ...... -------- (Draw existing and required addition on reverse side} I hereby certify that l 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 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 ermit Is Issued, I shall not employ any person in such manner as to become sub ect to rkman'soCompensati laws of lifornia." Signed ---------------------4----•--Q�--9�- Oame'r— By ----- ------------------------------------------------------•-.......... :''` ------•- Title ................... (if other than owner) FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTEC ------------._ syr+ ------------- DATE _~.�' -T- ----------- BUILDINGPERMIT ISSUED -------- ................. --•------_----------- ------•----------------------------- -----DATE ...... -------------------------- ADDITIONAL -•-•-------------------•ADDITIONAL COMMENTS -------_--------- •--.._..___---------------------------•-•--•----------- ------------------- --- ----• • •-_...- . .................................... ------------------------------------ ------------- ------------ ----------------------------------------- -----•------------------ ------------------ ..........................-................ ------------------- - ------•----------- --------------- -- •---------- -------------------...------.._.__.._..-------..__......_............. ..............................I---------- - -------- --------------- f=inal Inspection by: .. 3r -•----••-•-•--•--...--•. ..........................................--.._............................................Date ............................. --•--•---- EH 13 2h 1-68 1bev• 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M