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FOR OFFICE USE., APPLICATION FOR SANITATION PERMIT ,. -•............. {Complete In Triplicate) Permit No. ...7.......__.-_---- 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: JOS ADDF21: SS/LOCATION .. Q Owner' -�. .��-l.!__... � ----------------._...----...............-.-.:.CENSUS-TRAGI...........--.._.........._ a s Name :�_/ a-�..�....._..,. r ........................... ................... Address .._ 1_1��.. ._ .C ,•�s _ one ......- .--------•-•••• .............. City A�0.... ----•- Contractor's Name --- ........License # Phone __ _G� Installation will serve: Residence Apartment House 0 Commercial[]Trailer Court ] + Motel ❑Other----••_---..:_. } ............................... Number of living units:-../------- Number of bedrooms ...3--.-.Garbage Grinder ...... Lot Sure �- Water Supply: Public System and name -_ . � .....................................Private�. Character of soil to a depth of 3 feet: Sand --5ilt['j_ Clay 0 • Peau]—.Sandy.Eoam.{]Clay.Loom � � Hardpan 0 Adobe 1] 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.) N9W INSTALLATION: (No septic tank or seepage pit,perm€tted if public sewer Is available within 200 feet,) PACKAGE TREATMENT f I SEPTIC TANK l r--Slze_............................ . Liquid Depth .........................._ Capacity � TYpe o Compartme nts ...............--- .. 0 Distance. to nearest. Well Foundation . . LEACHING LINE [ j No. of Lines ` Length of;each line...... _-_74_........... Total Length ...._azd......... 'D' Sox .. Type Filter Material I • ..._._ ......Depth .Filter Material ....,./...f'....-- } �.. ........::.. Distance to nearest: Well ...... Foundation _......�.a.- Property Line ...... . SEEPAGE PIT [ } Depth _____ ___ __________ Diameter ....._.I-.. __ Number ----- --------------------- Rock Filled Yes IJ No � k Water Fable Depth .........•_-_._�'_". �... .......... Rock Size 7. -• . --=••-... ,i / 1 Distance to nearest: Well------ ell' .....:.._ ..Foundation .--- Prop. tine REPAIR/ADDITION(Prev. Sanitation.,Permit / .1 _. _. bate �' Septic Tank (Specify Requirements) .............. a Disposal Field-(Specify Requirements) ........ --•-••---- -----•- ----•--•-•-••-- ----• ------ s.................••- .-----•------•- r.� ----•- .... --•--••---......•.............................. ._._. ..... (Draw existing and'iequired addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinances, State Lows, and Rules and,'Regulations of the Son Joaquin Local Health.District. Home owner or licew sed agents signature certifies the following:,,"' "I certify that in the performance of the work for which this permit is issued, 1 shalt not employ any person in such manner n as to become subject to Workma 's Compensation laws of California." Signed/ - Owner By astf ------ -_------------- ... Title ---- ----- - •- (If other than owner] - - ............•- ........... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._.. -- BUILDING PERMIT ISSUED ..................... .. .. . ----.-DATE .................... .. s ADDITIONAL COMMENTS ...............--....--••---•-- • -•-•----�• •-------•�---...------�--•-• �- --••--••---------•-•----------•---••------------- •-- - -------------------------•-•------------..._--------------....... -------------------------------------------------- ----------•---- ...... -- Final Inspection b P y: _..... -•-•-- .. ........ .. ..........Date - ------ EH 13 24 1-68 Rev. SAN .fOAQUIN CAL HEALTH DISTRICT g�7a 3 f