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3a APPLICATION FOR SANITATION P1cRMIT - �............... Permit No. ..7.. --- �� (Complete In Triplicate) ---•---•----........ This Permit Expires 1 Year Dram Doh Issued 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 Ordinance No. 549 and existing Rules and Regulations JOB ADDRESS/LOCATIO a -.... ..ti... ...............................................CENSUS TRACT .......................... Owner's Name ....... .Q!.... 1n.!1 ., ..... ......... ............................Phone .................................... Address ..-"-•--.----•:.- a.7...... .. ---.......� ....' 'City .............................................. 1 gyp Contractor's Name ..__ - .:.. 9._ _ _.... -,..r...........................License .... Phone Installation will serves Residence 09,Kp--artment House 0 Commercial[3Traller Court (] Motel ❑Other Number of living units-------I.... Number of bedrooms .......Garbage Grinder -P� .. Lot Size -G f:� ............. Water Supply: Public System and name ......................--------------------------.._.._..---,_...................................Private or :. Character of soil to a depth of S feet: Sand 0 Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loom Q Hardpan❑ Aclobaio Fill Material ..l.! .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 240 feet,) PACKAGE TREATMENT ( SEPTIC TANK( p osize......_'1.�..., :. .. .... Liquid Depth _. ...�, .z-......`r1 Capacity ..�. �_...... Type l!�- �~�!_: Material. °: o. Compartments .... ....... ` Distance to nearest: Well' i .foundations....1.I�............. Prop. Line ..r. '_EACHING LINE [q----No. of Lines ..---�............... Length of such line... Q..r........ . Total Length ....1�f.�.�............ `D' Box ..N5.... Type Filter Material ..:020 G1l -..Depth Filter Material ......J40.�� Distance-to nearest: Well ... .. .. ......... Foundation s �........` .:. Property Line ... .J............. SEEPAGE PIT [ Depth ....c�s..�-. Diameter _. ..... Number ..........I................. Rock Filled Yes iso Water Table Depth .........W.........+.. ................Rock Sirs ' Distance to nearest: Well;., ./ .....................Foundation'....,��..{ , Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ........ ......................I....... Date ............... aeepticTank (Specify Requirements) ................... .................. ........---...............................e .................................,................ Disnosal Field (Specify Requirements) ........... .................... .....?... 4 • l r.............................................................................. i. .................................T.............._._................ .........__...._......................l. ...........................Y......................_._._..._._._....---.._... .................................................lli.......................................................................................... ................................................. (Draw existing and.required addition-on reverse fide) I hereby certify. that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ile** sed agents signature certifies the following. j "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 become subject to Workman's Compensation laws of California." fined ............ ................................. .......... Owner ' .-- .. . .,.... . Title ............................ By �.-..._ �... ....._._ ...------ . ......... d : �I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .. ....:... ..................----...... DATE . ...��-...`�:�.:..:..........:�: . BUILDING PERMIT ISSUED ................ .. .................DATE=.:......................................... ADDITIONAL COMMENTS ................. h..........-- -----•.....°,...... - :........ 1 1 _ ... .........-..... . .............. .._...� .. .. ..__.................- .•......r`:.- 4........... .............. ....... •....... .................... ....... ..__-..- ..... ............................ ... _ . _._..._....__ ' ' `R_ ........._.. Final Inspection by: .._ ! ' ....................................Date...J ".°�.1:`�.....---................ •. EH 13 2L 1`68 lav, 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M H