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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT .Z ............... Permit Na. _.... . '.......... _ lComplete in Triplicate} _::: .. This Permit Expires 1 Year From Date Issued Date issued �_' G.1 r� App icotion is'hereby _ ade 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION. .."tN_�.` _. Rd:l:( �?t4 � l �--_�.Y..I?.........................................CENSUS TRACT --------•-----..:..._..--- Owner's Name ................. ._ ._..... .T...l�.................----•••---........_._:....:-......------..-Phone Address ..... ......................... _ ... ,:._�� .0 �.N .................. City _...... 7"0 ! ........................ Contractor's Name -----•----.... ...... ,Alga......._.License# Phone ✓� ... Installation will serve: Residence❑Apartment House 0 Commercial❑Trailer Court 0 Motel ❑Other------------------.......................... Number of living units:............ Number of bedrooms .............Garbage Grin er Lot Size -------------------------------- al" 'C 7 - ----------- -- --•------ Water Supply: Public System and Warne �..��..........................Private❑ - ---------------•----•--••-------_e Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan Q Adobe 0 Fill Material •J 1 ` .._ If yes,type i (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side NEIN INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,} PACKAGE TREATMENT SEPTIC TANK } � ;-�_ Type ...:._..._ Size.........................................•------. Liquid Depth ....-.._................a Capacity ......... Yp Material.. . No Cam artments Distance to nearest: Well .....................................Foundation ...................... Prop. Line ----------••-:--_-_--- LEACHING LINE ( ] No. of Lines ------------------------ Length of each line............................ Total Length .--,................... 'D' Box ............ Type Filter Material .-•.................Depth Filter Material .............................................. Distance to nearest: Well ........................ Foundation ......................... Property Line ....................... i SEEPAGE PIT ( l Depth -------------------- Diameter ................ Number .........................--- Rock Filled Yes ❑ No C11 Water Table Depth . __.Rock Size Distance to nearest: Well"" Foundation ................;.... Prop. Lina . REPAIR/ADDITION(Prev. Sanitation Permit# ................ Date .................... Septic Tank (Specify Requirements) � .LS'.T_f.?`f. ' ...... :......... ------.....----_... . ----------••--------- I i Disposal field (Specify Requirements) 1cCl.01_f ' .......... O- --- ee _ ....................... -- ---...s- - ----- --- { (Draw existing and�fequired addition on reverse side} I 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 Heal&Districi. Home owner or licen- sed agents signature c-ertifies the foII6; ingi "I certify that in the performance of the work far'which this permit Is Issued, I shall not employ any person In such manner as to b me' ub' et to Workman's Co ensation.:laws of California." Signed '_ .� ©. BY ......... .......... - �_ nRTM title (If other thou owner) --------------------------------- FOR EPT USE ONLY APPLICATION ACCEPTS© BY .... .................................................. .............•------..._':.•___._.. DATE -'. .. .�..-. _: BUILDINGPERMIT ISSUED ---------••-- -----------------••--------------••----------••• •----....------------._DATE --......................................... ADDITIONAL COMMENTS ------------------ --... ------------ ---------------- ---------------- ----------------------------•--- ------. ---•------ ---• • ........ --- . ••---- _ Final inspection bY: ------------•...............•---......_._.._...---...._.._Date ... -_ ------ EH Z3 2h 1-68 Rev. SAN JOAQUIN LOCAL .HEALTH DISTRICTs, $ 4 3M N"��