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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �. Permit No. ..76 .P7/ �1 . ............................�_......_... _ (Complete in Tripliaxto).,... .: ' . . � ................................................. - x d ................. This Permit Expires I Year From Date issued. 4 � Date issue // "7.. Application is herebymade to the San .loaquin-total-Health-District for_a permit to-conitruet and. Install the work herein dsribed. This appliation Is made in compliance with Coimly Ordinance Na. 549 and existing.Rules and Regulations: - CENSUS TRACT J013 ADDRESS LOCATION .. L.-.... N �' - �. ....... I'1. ....':.':...._..�.......... .. ( ..Phone -�•'• ......... Owner's Name ...............G- ....i! 1. ..... i .. A�.... I ..... Address ... .........._ ...... .� � .. ._._ #. . y .. ... ..... .... :..... .! LI Phone .T..F�." 0 .. Name ---- ..._.... , y Contractor's Nr •. Installation will serve: Residence[Q Apartment House❑ Commercial❑Trallar Court ❑ �- - ----- Motef*OthO ........................... qq _.................. ................ t �_....,......,.�....,..,.,.�»« ..lam. Number of living units ........... Number of bedrooms Garbage Grinder ........:... Lot Slze . ' ,L 'I 'L•..............Private Water Supply: Public System and name _........:.......... .: Character of soil to a deFOh of 3 feet: . Sand❑ Silt❑ Clay ElPeat❑ Sandy Loam 0 Clay Loam ❑ i I "*�.---Ti jHar� Adobe❑ Fill Material .. .k .....I#.Ye=�type .�.sE. . •. ....... (Piot plan F s4i Ong size of lot, location of system in relation to wells, buildings, etc. must :6 placed on reverse s(de,1 NE1N.INStALLATION: (No se tic tank or seepage pit .permitted if public sewer is available witslin 200 feet,l R E PACKAGE TREATMENT ( ] . SEPTIC TANK I I Size........................ — ,liqui De . capacity E Material.............:........ No.-Compartments ....................... G + l— Pro Line Distance.to nearest: Well ................Foundation .........-.•••• p• LEACHING LINE No. of Lines .......-. Length of each line................. ... Tota1 Length ...........,................ [ 1 y ...De Depth-Filter-Material' . ax�:.�...:..>:. Type Filter Material ................. p � ..................-- - I Property Line ................ 1 ----•----•--- Foundation �, p rty } Distance to nearest; Well ........_.. #........................ { SEEPAGE PIT '[ I Depth f Diameter Number ........ tock Filled Ye: ❑ No Rock Size r Water Table Depth , I t Distance to nearest- Well foundation. ............. Prop Line ..................... . Dated �.�,� RIrPAIR/ADDITION(Prev. Sanitation Permit ` ...................... ....... .......:....:..... ... It Septic Tank (Specify, Requirements}. E ..... ••-------•--------• ................ Disposal Field (Specify Requirements) ... � ....--------• • --• �.. I ---------------------- ..............•.......... .. .._ ---- (Draw existing and required addition on reverse side? I hereby certify that I have prepared this application and that the work WAI1 1F*d"0 in accordance with.San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:011strict.Hem* owner or liven- p sed agents signature certifies the following: arson In such manner ] ' "1 certify that In the performance of the work for which this permit Is issued, I shall not employ any peon as to becatne sub{ect to Workman'�.Compo saf onj i`a,,w f-Califarnta:' Signed .............. .................••--_..---- Owner BY -------- • --- -------- ---------- ----------- - title .-._ ---- . ........................ ................. f of a than owned FOR DEPARTMENT USE ONLY 4 DATE .,X .. .,_.... APPLICATION ACCEPTED BV ._-�� .. .......... . .. ............._-_----... _._..... --------- `- -- -------•-.._._DATE .....................................�...__. BUILDING PERMIT ISSUED .:---- -------- . ADDITIONALCOMMENTS --------------•-• .............................. ....................................... ••-----------------------_ --------........;..... --------............_... 1 ------------------------------------------•- .I ............_..........--.................. ------- -_.... - Date _.. � ._ _. ... ...... B Final Inspection by: _...---- �._._t.......... ............•------------...._..---- ...:..._...__.._..._.. . I' Mi 13 2h 1.68 Rev. 5i ] SAN JOAQUIN LOCAL HEALTH DISTRICT �7h 3�