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FQR OFFICE USE: ~� • APPLICATION FOR SANITATION-PERMIT Permit No. (Compieteln-Tr[pllcatel .................................................... . Date Issued . This permit Explres 1 Year From Date Issued � > - 7 6, Application is hereby made to the Son Joaquin Local Health District for a, permit. to construd and install the work herein described. This application is made In compliance with ounty Ordin ce No. 549 and existing Rules and Regutaflons; : �... ........................CENSUS TRACT ........................ - JOB ADDRESS/LOCATIO .... Owner's Name . ......... . ....... ...................................Phone . .............._ Address 1�/. C = ........City .....--•-...... . . � .. r.�. .....License # G. Phorie _ ... Contractor's Name ' + Installation will serve: :idents Q Apartment House 0-Commercial QTralter Court Q Motel❑Other.............................:.......... ..... Number of living units:............ Number of bedrooms Y4..... Grinder ------------ Lot Size ---------------------- ............ I Water Supply: Public System and name --- ------------------------ -----------------.r...........................................Private Q Character of soil to a depth of 3 feet: Sand Q Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loam ❑ Hardpan[] Adobe Q FI11 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.1 I Size-..........:...................•............... Liquid Depth ........................... .. Capacity .' � Type No. Compartments - oterial.................. .�.. .� Distance to nears t• Well "__.... ." _. Fqundation ...................... Prop. ins ................... o L �.rK Total Length S - n ... LEACHING LINE [ I No. of Linea ......................cf 'ten a ea line_. � �. . ..._............ � 'D' Box .,�-------- Type Filter Material Depth -Filter Material � ............................. ...... .� �--- w :3 Distance:so°Weare:#==Well Foua►dation,_::.._......Y...--- Property Llne, • - SEEPAGE PIT [ [ Depth .... .............. Diameter ................ Number .... .............. Rack Filled Yes ❑ No [ , .� Water. Table Depth _ .......................tock Size --"........... T p _.. _..._�.................Foundation _... _........... Prop. Line .._..... ' ., _ Distance to nearest: Well a � REPAIR/ADDITION(Prov. Sonitatiori Permit ............................................ Date ............................:.....1 ' Septic Tank (Specify Requirements) ..................................................................................,............................. . ....._... .. .a Disposal Field (Specify Requirements) ...................................................... .................................................................................. ...•-•-•----••--•.......-•----•-••--•. ................................................................ _..... ..........................._.... -•.............. . . .................................................... -----••...............•--- ................................ ........... ........... • _....................... � � (Draw existing and required addition on reverse side) ! hereby certify that I 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. 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 persalt in such manner as to beta a subject Compensation laws of California." Signed ....................................................... Owner ... . . - 7itle ........................................................................ 1 (If other than owner) k FOR DEPARTMENT USE ONLY L r APPLICATION ACCEPTED 13Y ....._. .. . . DATE .... ......_. BUILDING PERMIT ISSUED E ............DATE ..............................:.........:.. ....... ADDITIONAL COMMENTS ............ ...:................. ............................................................................................ ............................................ .................................................. ...............I........ " ..... .. -- --------- --- -• % .....................................Date.. ............. r. .�o............ .. .............................. :1 Final inspection by: ----. Irl{ 13 2(t 1-68 v. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3� J E }