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FOR OFFICE USE: p APPLICATION FOR SANITATION PERMIT ................................................. ..• Permit No. - ' �Q ;tramplers In Triplicate) ......•.. . .................................. ............................... _..._ y -- 9 Date Issued .................. This Permit Expires 1 Year From Date Issued :.__..._.. i 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. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATION d 'A �/A .4.ve-,-•-•---•-•-•---.:--••......................CENSUS T Cr .................... . Owner's Name 1_ CjA).... i!1.Q.._. __...�`_ .1...E7.j ...............................: ..:....... ........Phone O�J "f , - Address �Q- '� /1l 1 .... .............City . .. . .�91V----�-..�rQ✓.....• ... Contractor's Name ......•-----.License # ..._.._... Phone ......:...................... Installation will serve: Residence❑Apartment HouV mercial(]Trailer Court f] Motel ❑Other. ..... Number of living units:_-../..._ Number of bedrooms • 2.—.-Garbage Grinder ............ Lot Size. : ................... Water Supply: Public System and name .----------•---.....-•---•--......._..........................--_................................._.._.....Private Eg-' . Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fg Clay Loam❑ . ......� .T �...... Hardpan❑ Adobe❑ 4— Fill 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:) 1 NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) i PACKAGE TREATMENT of ] SEPTIC TANK Or-', Size. .................................. Liquid -Depth <. . �Capacity ._..- Typ es: 1Material. � Distance;to nearest: Well s:rQ_...........................Foundation ...2L.......... Prop. Line . .._-•! LEACHING LINE No. of Lines ... Length of each line.._. 0..... Total Length 'D' Box --•.- Type F€Iter Materiand _ �epth Filter Material , -`...................•--__---= •��.�' Distance'to nearest; Well ...................... Foundation ----------..--.......... Property Line ..................... ( ( Depth --_ ��..---.. Diameter ��k ___-. Number ........ :....:............ Rock Filled Yes No [] e I/ it Water Table Depth ...Is--- fRock Size ...m�..----i-. O .... Distance to nearest: Wel! CMPw_�i ............................ AP Prop. Line ..6........_...... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............................_-----} Septic Tank (Specify Requirements). • Disposat Field (Specify Requirements) .-•--------- ----------------•.... ........................................................... ............. ----------------------------------------=---------IL......... ------------ ------------ ----••-•---•--- ----•- -•------------•--- •-------•----- ••. - _u.. ......-•------------------------------------ -•••----•---------- = = -.= .. e_ (Draw existing and required addition on reverse side) t 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 Health:Dlstrict. Home 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 person in such manner I as to beco sub' ct toWor naris CoTpensimpon laws of California." Signed __ -- ----- -------------- Owner By ------------------•------_-------------- ---------------.._..------------------ •----•------••--•. Title --------•-•---- (If other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- .--------- DATE ------- ..-_-7\4S ..........: BUILDING PERMIT ISSUED .,...- --------------------DATE - .......I. -- ••----------- ADDITIONAL COMMENTS ----- -------------- ..... - ---------------.:.-•---------------- ------------------ ...................... ----- ----•-•--- ---------- ------------------•---------------------------------• --------------------------------------------------------- - --- - - ............ -• - i --- --- - ..... ........ --•--......--•---------...------...... ........_.....--_.... ---. •. _........... Final Inspection by.. ...Date .f--... M 13 24 1-68 Rev. 5M SAN OAQUIN CbCAL HEALTH DISTRICT 8/7h 3M