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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT ........... Permit No. .�.`.`�� (Complete In Triplicate) ,....... .. . .............•.................................. Date issued ...1: �:.76 ' This Permit Expires 1 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 1 ode in compliance with ounty Ordi ance No. 49 and existing Rules and Regulatlons: 1 �G � .CENSUS TRACT X013 ADDRESS/L TION b ......................... . Owner's Name .`.. -•-•--•...........................•--................... .......... Phone'7'�� .�`�� ...._.. Address .. ..--- ................City . ..... . .. ' ............. license .71.53 Phone . ............................S. d:/ Contractor's Name ...-_ �.?. --•- -• . . installation will serve: Residence❑Apartment Hou fl Commercial(]Trader Court 0 Motel 'Other •. Number of living unite:............ Number of bedrooms ---... ..Garbage Grinder ............ Lott Size ..----•-•-- Water Supply: Public System and name -----------------------------------....................._...................................................Private, Character of soil to a depth of 3 feet: Sand 0 Slit❑ Clay 0 Peat❑ Sandy Loam 0 Clay loon+Er � Hardpan (] Adobe(] Fill Material ............ If yes,type--------------- ------------ Mlot 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,( , Size. a�.?� p PACKAGE TREATMENT ( ] SEPTIC YANK �. ... . ..............:....:.);quid Depth .._ .._......._. ........ Capacity .�G? --•- Type .e�Material. . . ...:. No. Compartments ....�--- --• Distance so nearest: Well' ....._ ..Foundation ....... Prop. line TEACHING LINE I ] No. of Lines .............. Length of each ................. Total length ........................I C,j 'D' Box ............ Type Filter Material .....................Depth\Filter Material .....................................� Distance to nearest: Well ../.......... Foundation:........................ Property line .............. SEEPAGE PIT (L Depth ..D7 ,....... Diameter. -.'O ,••••• Number ...../.................. Rock Filled Yes go( ' N Water Table Depth . -3.40........... ...................Rack Size 49...X3... ........... ` Distance to nearest; Well ..Foundation ... ....•. Pro line `...•_. r'. .... :] p• f�{ REPAIR/ADDITION(Prov. Sanitation Permit# ....•.....................•-•---............ Date ............................... .1 � Septic Tank (Specify Requirements) .............. ...........................:..:......... .. .......»....»..... :.:.............: ............_................. ..fi �s/' TVM bW5(6nl o.. t MPQf !9: .....IAr............. f Disposal Field (Specify Requirements] .... ................ .... . ---•-- .. y t ....................................... ......... . . ........................--- ......................................................•-....'` .......--..---:.....•--... .........�.: I-0................ (Draw existing and required addition on reverse side) .1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin :ounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Honte owner or Ncen- 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 beco b ct to W on's ompensation laws of California. Am„ :flneG' �y ...................... ...... i........_ ..... Owner ay ..... ............ ... ...... , -.... . Title .......... : (If other than owner) ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...- . ............................... DATE ...�,/�".. �. .............. BUILDING PERMIT ISSUED `r 1:. ......DATE +.,. `ADDITIONAL COMMENTS ......I .... ......... -•---------- .... .. i.................................................-........ ............... . /. ...._.... ::. ......... .....•... • ... ........-.Date : . .• ..� :..::* .. R Finallnspectio .. .. EH 13 2L 1-68- liar►- ..5M ' SAN JOAQUIN LOCAL HEALTH DISTRICT _ 8/74 3M