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FOR OFFICE USE:o� APPLICATION! FOR SANITATION PERMIT ...................................Z.-.! G : [Complete In Triplicate} Permit No. • S_..-......3 -•---•........................................ This Permit Expires 1 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 Na. 549 and existing Rules and Regulations: ' JOB ADDRESS/LOCATION ....... ...c. ./ ..----- ��: � ..............................................CENSUS TRACT .......................... Owner's Name _.. ... ............ ... . .........................................................................Phone i�.177.:,A _ . :.�D.� ? .j-------_.-... ••-- city ....... � ..................... Address . _ .. ._/.....��_:..!`_�._.- -... _._.. ..._._ --•- •-••- . •• gg Contractor's Name .__ .._ _ Wf��.,License # _..... . Phone .... ...- ... _.-- Installation will serve: Residence PfApartment Houseo Commercial❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:-./------- Number of bedrooms _._.._Garbage Grinder ............ Lot Size ,147 Water Supply: Public System and name ......... .------. !'...T.._l�.................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam ❑ Hardpan ❑ Adobe)k 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 240 feet,) . PACKAGE TREATMENT SEPTIC TANK Size--_ X. r. } t ] -�-- �•�.................... Liquid Depth ..�:*--.......---...._ Capacity A~------ Type-�a'PW1RMaterial. _. No. Compartments ...`# _._._... �f Distance to nearest: Well ...._��P.r.....................Foundation -----/a-?T........ Prop. Line .......0..... LEACHING LINE No. of Lines -----!9X Length of each line.------ ............. Total Length ...... .�'....-� 'D' Box _____!.__... Type Filter Material ..-jV• "/.C-Depth Filter Material ...........le........................ Distance to nearest: Weil ----ZiPe_....... Foundation Property Line -----CSF...---•••.••.5 f _ SEEPAGE PIT Depth ---- ---------- Diameter ----------_--- Number __._....._�...............Rock Filled Yes)2Y No �A Water Table Depth ------------------------------------------------Rock Size .....2-••sem............... _ !� Distance to nearest: Well _..---- - --`---• --------...Foundation ---.-..e .... Prop. Line ........ .�...._.-� REPAIR/ADDITION(Prev. Sanitation Permit# _............_..................___...... Date ...................... SepticTank (Specify Requirements) -•.....................•...---------------------•----------------------------•----- ........................................................... Disposal Field (Specify Requirements) _------- .........---•-•--••............................••-•-- ------- ------•- ----------------------------------------•-•-•-•-----•-- -•--•---•---—-------• -----•-- -•-••-----•----- ----- -- (Draw existing and required addition on reverse sidel I hereby certify that 1 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 San .Joaquin Local Health,,District. Homo 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 become subject to Workman's Compensation laws of California." Signed ----C rW? C ------c�--tc1 _._..._ �_ Owner '44 By ----...-.- -------- ............. Title ------------ -- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ---------- -- ----------------- -------- --------------- DATE .....--. ------- BUILDING PERMIT ISSUED -------------- DATE --.........-------- ADDITIONAL COMMENTS - .. ................................................................. ----------------------•------- ••----------.......--qJOQuIN - .............................................................. ....._..._....._....---------............. --------------- --------- •---•-•----•----•Final Inspection b Date ...... .. ..,� a EH 13 2L 1-68 lb--v. 5M SAN LOCAL HEALTH DISTRICT 8/7h 3M