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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT � f ...................................:. (Complete in Triplicate) Permit No. 1..�P--------------- .......... ': : This Permit Expires 1 Year From Date Issued Dare issued r 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 an existing Rules and Regulations: I/ JOB ADDRESS/LOCATION __9JJOB VRS, = : _ya S"` ...............................................CENSUS TRACT Owner's Name ............Phone ®t� Address _10,If f--M k.l 0 H,_...J C.>........... ...._.._.._....._...T Ci S'Z�d.l/i' $.✓ Contractor's Name .----•--•-•--------------,_,... .............License# ....... Phone Installation wilt serve: Residence[]Apartment House❑ Commercial❑Trailer Court 0 t. r , Motel ❑Other... . u ,r Number-of living. units:-:---------- Number of bedrooms ............Garbage Grinder Lot Size Water Supply; Public Systemand name ........_.................... ...Pr€vats ❑ .._......... -- ................... Character of soil to a depth of 3 feet# Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q Hardpan 0 . Adobe 0 Fill Material ............ If yes,type............... ............ (Piot plan, showing size of .lot, locat€on of system In relation to wells, buildings, etc. .must be placed on reverse slde.y NEW INSTALLATION: (No septic tank or seepage pit permitted,if public sewer is available within 208 feet,) PACKAGE TREATMENT ( ] n _.. . SEPTIC TAMC ] Size.......................... Liquid Depth _ Capacity T _.__... Material..:•---------------- No. Com artments 4 Type .... _ __.. Distance to nearest: Well .. p . . _. . s __Foundation .•--•.---.-•--.. ...._ Pr - � op. Line ...................... LEACHING LINE [ ] Na . of Lines ............. .- Length of each line..........................._ .Total Lengthk ---•--•• D' box Type Filter Material Depth Filter Materialrn Distance toInearest: Well __•....:................ Foundation 2n,_ Property . SEEPAGE PIT ( } Depth ----------- Diameter Number Rack Filled Yea ❑ No �[j Line _ ._.. Water Table Depth ---------------------------------------------Rock Size ....--•-•--------•----. Q l Distance to nearest: Well ...__......._.. _Foundation . Prop. Line �. REPAIR/ADDITION(Prev. Sanitation Perm at#................. Date ............... :.....) „ . Septic Tank (Specify Requirements)._.------� '� -dam_..©�...__ --•-•--•--....-- Disposal Field (Specify Requirements) _ _ - -I__-•�-••--•-•--•--••-------9Q ? oa��j� i�la.B - ---------•, -- s t -•--------------• - i Draw existing and required addition on reverse side) .......................... ; I hereby certify that I have prepared this application and that the work will lie done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;Distdct. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner. '05 to bec subject to orkman's Compensation laws of California." F Signed . .............. . ..................... Owner I` SY - ----------------------- �-.- ----------• title _.... . •. .�_.... . -- ._...._ (I otherthan-owner) . FOR b P RTMENT USE ONLY 'APPLICATION- ACCEPTED BY _ J� . ... ....... .. .. ------------------------------ ----- DATE ..,..�T`j ` BUILDING PERMIT ISSUED _.. -r---- r _ ADDITIONAL COMMENTS .. ... ---- - -------- :i------ ------------___________________ ____ _________ ! __ ___ _ ______________________________________.._.___.._-__..._.___.._.._....._._..._-._.-- Final Ins ection b P Y� -- -- - :�---- . .. _ _ ... ----------------- ------- ------------•---------•---•_Data .�—�-- �.��-t..��._......--- EH 13 2h 1-68 leve SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M