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rwr. vrrrc,C USE: 1 —-- APPLICATION POR SANITATION PERMIT IComplete in Triplicata) Permit No. ._7 •: �7 ....--•--•......................... ••------- --------• This Permit Expires 1 Year Front Oat#Isssed 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 compliant with County Ordinan No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._.. lv.._._ .. Owner's Name ......................CENSUS TRACT .......... ............. Addre ....� ...PhonegvZj.r.9..,3-f 9 ss/8'�.�� _..- . .----.. ................... ........-...................... City on ractor s Nome __.._._..._ _ -� .... _.._...__ ._ ....License #a,�l�a� _... Phone ..� lr s--_a•C/� Installation will serve: Residence )Z�Apartment House[] Commercial ❑Troller Court 0 Motel ❑Other..................... Number of living units------ .. Number of bedrooms _ Garbage Grinder Lot Size Water Supply. Public System and name ------- Character of sail to a depth of 3 feet: Sand"W ....----- -•----•. ••..•---..._...._ _...Private, Silt❑ Clay ❑ Peat❑ Sandy Loom 0 Clay loam [:IHardpan 0 Adobefl 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK l ) Size--------------------------..........------------ Liquid Depth Capacity -------------------- Type .................... Material--_---------- No. Compartments Distance to nearest: Well .............. Foundation ....__................ Prop. Line ................ IN LEACHING LINE • "-• [ ) No. of Lines ------------------- --- Length of each line---.---_---....___... ........ aterial ............... Distance to nearest: Well --------_----,__„---- Foundation ........................ Property Line . SEEPAGE PITDepth ..... ............._ Diameter ................ Number .-----. ._...__-.--_._...... stock Filled Yes ❑ No �] �` [ ) . Water Table Depth -------------------------------- . ..Rock Size -------...._._.--.....- -- • -•- Distance to nearest: Well .......-•---------------- .......Foundation .................... Prop. Line ............. .........j REPAIR/ADDITION(Prev. Sanitation Permit t# ............................... _...__. Dat Septic Tank (Specify Requirements) ........ ........... . Disposal Field (5 ecify Requirements) ...------ ...... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accardance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Nom* 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 as to bet ble t to Wo; ants mpensation laws of California.,, Signed ----- ---- Owner BY .Gl? _ - Tit#e _...... • (If other than ownerl FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- --------- ------ TE ...... r_zBUILDING PERMIT ISSUED _.. - �DA TE ............ .......................... ADDlTIONA! CQN�VIE TS _._.. - --- cr----------- ----- - f ✓�/� ��` --• ------------•----------------- •--•--- ...--------•-------••------•-----•-• ---•-- fC.d_u ----..._.. ' LQrIeC' 5..---- ,�y •------ ...... ---------------------•---•---• ---------. ---------- _ ins Inspection b ----.._. _. ._ _ •-•......:................•_.._--•--- ----•-- ........_ EH 13 2h 1-68 herr. Date _...... ...-_.$'.....��..--- ...- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M