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FOR OFFICE USE: APPLICATION FOR SANITATION PERM IT � - F (Complete In Triplicate) l Pe►mit Na �� W. Hate Issued ,P.._.-V _.........:............................................... This PermltExpires t 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�inance No, 549 and existing Rules and Regulations: .106 ADDRESS/LOCATI .. .2�....�..-- - �_... ............................ ......................CENSUS TRACT ......................... . Owner's Name . .. .. 1�..-.--.. •.. ... ................................ .. Phone ............... Address . . .. .. ��... . _.. ............ City f...............:.......................•... .. Contractor's Name .. �- ... ...... ...........................License #,� ��e�y Phone .........................-.... Installation will serve: Reswence R-Apartment House Commercial ❑Trailer Court ❑ Number of living units------- _--•- Number Motel ❑Other ............ -._�.................................. .G ••....................... j ' umber of bedrooms Garbage Grinder tot Slzel1�f�r.63 i',2�LI ,'z-I3 Water Supply: Public System and name ....Private Er Character of soil to a depth of 3 feet:. Sand E] Silt❑ Clay, ❑ Peat❑ Sandy Loom Q Clay Loam ❑ Hardpan 0 Adobe ill Material .......... _If yes,type ............... ............ IPlot .plan, showing size of lot, location of system in relation to wells, builtlings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 400 feet,) PACKAGE TREATMENT [ ] SEPTICTANK I l Size................................................ Liquid Depth .......................... CapacityType _ Material...................... `No. Compartments ' Distance to reaves# Weli .......Foundation .. p. Pro ire . LEACHING LINE No. of Lines- [ � nes - ---------------------- Length of each line.................'..:...... Total Length ............................d 'D' Box -------- Type Filter Material ....................Depth Filter Material ...._.........................-......`.. ; Distance to nearest: Well ........................ Foundation ...... ...........:.... Property Line ..._.._.. .......... SEEPAGE PIT '{ }`. Depth ...:.°.. ..-- ..-� ❑ . Diameter`--:_,_-___-. Number ...........:.. ... .. Rock Filled Yes No Water Table Depth Rock Size ... :.:.......: •--- Distance to nearest: Well --------- ----- ----------- Foundation ........ Prop. Line .......•........... REPAiIt/AQDiT10N(Prev..Sanitatian Permit ��/d---- ._.::_-:. ..:..... Date'_l- �. --3-:---••} Septic Tank (Specify Requirements) ..---•-•------- -- -----•-----_----• -- -.........:........_. :y............. . ............:.... ...........-�— i ate Disposal Field (Specify Requirements) (/l� --7n Al2 ...�-`-4'• X `�•-- -- `'` u/ ""•- ... ............•.....-- 6 (Draw existing and required addon�on reverse side) I hereby certify that I have prepared this.application and that the work will be done In accordance with San Joaquitt County Ordinances, State Laws, o6d Rules and (Regulations of the San Jooquln Local Health:District. Home owner or [icon- sed agents signature certifies the failowing: "I certify that In the performance,af the work for which this permit is Issued, I shall not employ,any person In such rnannar I as to become subject to Workman's Compensation laws of California." Signed --•-----•--•-•----------------------------- Owner -- By ---•..-- • ------------------------------------ le-1--- --- ' ' e ----------- --------- Titl (if other than owner) i FOR DEPARTMENT, USE ONLY APPLICATION ACCEPTED BY -Q NQR. KD_-••----- ,..DATE.:..W. BUILDINGPERMIT ISSUED ....: :... .......... .......................... ----- .-------------;....................•-DATt: ..-.--•-- ..................__........: ADDITIONAL COMMENTS ----------•- --------------------------------------------•-------•.._..----•---•-- ' ------------ ------------•------...... .......... .._-...---- - `� ...._... ... ............. - - -------------------- -- --- ------ ---- final Inspection by: . -.._..':_.._......-•---....._Date -- -. '- EH 13 .2h 1-68 Rev, SAN JOAQUIN. L CAL HEALTH DISTRICT 874 3M d ,