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FOR OFFICE L1SE: APPLICATION FOR SANITATION PERMIT Permit No. .............................,. .............. ... }Complete In Triplicate) ...... ................................................ _ - Date issued :; ...... This Permit Expires t Year From Date Issued Application is heresy evade 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. 544 and existing Rules and Regulationst JOB ADDRESS/LOCATIOAI �. .. ,.P � .� .:.......................................CENSUS TRACT ............ ..... .... Owner's Nome!i..'C.zZ.,-;. .................. ...,...................... ................ _................Phone ..�.Jv��+. lP�....... -Address ...c'1..:%..,�7. -_ °,�.... :_ ..............City ..... _... ... ................ ....:........ --- q--- Contradpr's Name .._!,�%:� -:.. r -................... ' ..License # .... . ........ Phone �:• Irtistallotion wil[:,serves Residence at-4partment House{] Commercial❑Trager Gaunt ❑ Mote! ❑Other------------------------------- ............ i si -Number.,of 'g units::::-....... Number of bedrooms .,.,,.__Garbage Grinder ............ Lot Size ...................••-..._..... ............ livin Water Supply: Public System.and name ......................................••- _......................._................,.........Private -Character of soil to a depth of 43-feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam{] day Loam ❑ 'Hordpon❑ Adobe❑ Fill Material .... .......If yes,type............... ........ . . . {Plot pian, showing rise of lot, location-'of, system in reflation to wells, buildings, etc. must be placed an reverse aide.} NEW.INSTALLATIONs Wo septic tank or seepage pit permitted if public sewer is available within 200 feet,) MENT ( ] SEPTIC TANK I ] Size................4............................... Liquid Depth ..............,_............ 4� -M ........... No. Compartments ......................d PA r Capacity.//do�pa -_... . t oundation Prop. ----- ------- Distance to nearest•'WeH :...................:f ..........-- i� ' :......... :a`f;eadix line. .................. Tata! Leg Line LEACHING LINE [ } No. of Lines . Length 7® nth _. •... Type Filter_Material _ .�..'+.-Depth filter Material ..�� ........................................ £ 'D' box4 w -- ... Property Line .--.. Distance to nearest: Well ..�pP....::........ Foundation ��........._.._. . .. ........_ SEEPAGE PIT ( } Depth ........ ......... Diameter Number . Rock Filled Yes ❑ Ni C3 R. Water Table Depth .......................... :__z........`:.Rock Size .................. .............. Foundation .... Prop. Line 11 Distance to nearest: Well ......................................... ....__.......... ..................... , REPAIR/ADDITION(Prey. Sanitation. f........... Date Septic Tank (Specify Requirements):.......... ................. . .z.. ... .............................._........ ...................... .............___...... , ...: { Disposal Field (Specify Requirements} ................- '-•-•-•-= -----._._..-.-................................------------.............. ....,...........-. } ................. ...._ ..................................................................................°...... ............................... _ _..........1' :. .....................................n t ........................... . ....... ................................_ .�..... .. «.... .... __... .. (Draw existing-and'required addition on'reverse aldol _ , ii� r4 I hereby certify that�l-haveprepared this applicaBon".and that the work will be done Ir: accordance orifi, San Joaquin County Ordinances, State Lows,'and Rules and Regu16 o'ns of the.San Joaquin Local Health District. Herne owner or dicen- sed agents signature certi"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 became subject to Wdrkmein's Compensation laws of Callfornia.°' tk: ' Signed . �K r :.........................,,..........::"__... Owner I .�............................................................................•--•---- jitle ............... ...................` ..........................7 1 j (if other than owner it r R DEPARTMEN "USE ONLY i 77. APPLICATIONa,`ACCEPTED:BY .._- ,. ...........-...............--. DATE ... ..; ........................ BUILDING PERMIT ISSUED ....DATE .......................:....:.............. ................•••. ADDITIONAL COMMENTS -, .................................................................-................................................... ................-........ .. .•..................'..................:... .-.... ...-..... ............--............... .-...................................................... ...-...•............ .. :••--•• . . Final Inspection by: .......................Date . ...-.-:. .`-.:_.................. ... EI{ 13 2h 1-68 Rov. � SAN JOAQUIN LOCAL Hf:ALTH DISTRICT 8/7h 3M