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FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT I (Complete in Triplicate) Permit No. .................. ••••••••• Date Issued ...�------."............................. This Permit f Year From 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. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATIO .... ...._.. .-... Owner's Name •- _-- ---•---- -------------•. ._.. _ .Phone ........... .. ........... Address 4 ' -.._ . . _. i --- ... ........... L Contractor's Name i `C •tX . ...-•n . c . -a-.: . .. 'cense'# Phone installation will serve: Residence jSAportmen:t House E] Commercial E]Trailer Court, 'O l :.a:: _: .: " = Motel Other-::. �_._... f Number of livin units .- ,-Number of..bedrooms... - 9 � Garbage .Grinder --------- Lot Size ......... Water Supply: Public System and name ..... ........._. ' �.,,��•� . . . _- Priv to L:T Character of sail to a depth of 3 feet: Sand'El: Silt Q Clay. ❑', Peat�] ! (Sandy. Loam-E] ' Clay loam,❑ ` i .i. Hardpan Adobe F E3ill Material _ ,`If yes, pe . .... . ... .c. - i ;.l ......... . ... {Plot plan', showing size- of.loj,-ioc6ti6n of systerrie.in :relation to.,we4l bualdir gs, 'etc..;.must .be.placed on`reverse side;# NEW INSTALLATION: (No septic tank or seepage,pit perrnitted if public sewer is available within 200 feet,); J/ PACKAGE:TREATNIENT ( ] SEPTIC TANK( Sizef�.//t` AX'S" — Liquid Depth _ f ......._ .t.J i Capacity d .. Type Material .No i Compartments a �- Distonce to nearest Wel) j�¢'_ Foundbtion /d Prop line __.__:_.,`1.� LEACHING LINE ; `_ t { L n i1f s ] No. of Lines . J Lngtli of`each line ;. a.- F... To al e th / �'.. _.. 1 D'--'Box I YP feria!-:_._ _`� 1, i : -.:_Depth :Filter _Material • T e F.ilfer His Distance-to-nearest. Wel! Foundat,ot --- PropertyG Line . 7- :_" r a [+'� Depth o - - Diameter ___ �' N+Jmber SEEPAGE PIT _ ` :Rock Fileted Yes [ No All Water. Tab.ie_Depth:............. .�{ ------:---- -Rock.Size _. ...... I Dis:#ante to;,nearest:•Well ....... : Found_ation .. .. :o :_ Prop. Line ......... 1 REPAIR/ADDITION(Prey. Sanitation;Permit# .- ?• . , .Date . Septic Tank {Specify.Requirements}. _ " iDisposal Field (Specify Requireriments) .. .. _ ------- -------------------- ......... .................. •-- } ...... -_.... , .. .----•- . ----------- ................... - ...... _. : .. .. . - --------------- r (Dra'w existing and required addition on reverse side} I hereby certify that I have prepared:this application and than 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. Nome owner or liierh sed agents signature certifies the following: :. - "I certify that in the performance of the work for which thisermit is issued I shall not i p employ p y an y person In such manner , as to become subject to Workman's CoMpensation laws of Cali;ornia.'" Signed!.:.. -- w g ....-- -- ---.._---•-- � ---/`�-r- - ------� - - - •-• ---------- Owner", - i (If other than owner) F DEPARTMENT <<SE ONLY APPLICATION ACCEPTED BY . , --�--•...... ......... ...... DATE �c7,�.---.fes.......--•--- BUILDING PERMIT ISSUED :'-.. ' QATE .........:...........`......:. i ADDITIONAL COMMENTS ,..... ------------ --- ........................... .---- ---- - ;... .................. •------- ...---- - ..-- --'.. ..--` ......_..... t ......._.. --------- --- ------ ------- - --- -- --- .. --- ------------ Final Inspection by. . ..---- ---- ....... p . ..............:... ... •--• cite.-1 '00V-:7.. --------•----- r �SAN_JOA`QUIN .LOCAL, HEALTK DISTRICT E. H. 1.3 24 1-'68 Rev. 5M lay u