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FOR OFFICE USE: APPLICATION FOR SANITATION„P€RMIT ............................ - ............. [Complete in Triplicate) Permit No. ................ Soh e . - s ..........................................:................ this PenniltExpires '1 Year From Date 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 mode in compliance with�County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . . 0.9-9 � � ` -4�/.._._ .............CENSUS TRACT .................. Owner's Name ............... .. . -31 L r �.,G .,. .Phone c��l.._...�..................... Address . ......... �o.S ....:.. .�!'` { . ......---.... City . 1'-4�-R�r�rr�. �.. ..,! } .................... Contractor's Name -----•------- .... ....... ................ ......--.......License 111A. .1. ....... Phone 7�.rP.'g4d7....... Installation will serve: Residence[?Wartment House Commercial❑Trailer Court C] Motel ❑Other ........ ........................... �- Number of living units: ..... Number of bedrooms ___-_;�.-`�Garbage Grinder .......... Lot Size . .................. Water Supply: Public System and name ......................................................................................................:........Private Character of soil to d depth of 3 feet: Sand[] Silt Q Clay ❑ Peat❑ Sandy Loom ❑. Clay Loom ❑ Hardpan ❑ Adobe fl Fill Material ............ If yes,type ............... ............. (Plot pian, 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,) PACKAGE TREATMENT f ] SEPTIC TANK . ze......-d -.�5...............:.......... Liquid .Depth �.il-_ ............. Capacity!_. � _ :_.. Type-.A... r Material...4;e�y� No. Compartments ..:.2.......... Distance to neores : Well ------------!P----.................Foun��ion ---1.0............. Prop. Line -5-----_•- .--.-- LEACHING LINE Cj No. of Lines .._ _ ._. Length of each line------- Total Length ....�� ...... N �r V1 'D' Box ... Type Filter Material .... ,/��: --.Depth Filter Material ..1 ................................... Distance to nearest: Well ._. o_.`.�-_----_- Foundation ..�t.-t.......... Property Lige �..� M ... ............. . SEEPAGE PIT p . Diameter _ . Rock Filled Yeses No ❑� l l Depth ._.�..-- -_..._. s1..�a.--- •--- Num$er ...,.....---•---•--•....._. Water Table Depth ... _.Rock Size�. `.............. Distance to nearest: Well .._l � ....._Foundation x/10.- Pro tine 11, i� ---•- p. M REPAIR/ADDITION(Prey. Sanitation Permit'# __ --------•...................._-2-- Date .__............................. Septic Tank (Specify Requirements) ------ ••• ......................... =` - ............ -- Disposal Field (Specify Requirements)---------------------------------'--------------------................................................................................. •••--•-- • ------------•- ---------------------•------------------ -•--------------...__...................---------•-•••••--................... (Draw existing and required addition on reverse side) I hereby certify that l 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,District. Homs owner or licen. sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall nag employ any person in such manner as to become subject to Workman's Compensation laws of California.” Signed ---- - ---- - Owner By -------- ----- ` - ---------- ------. Title - .......... (if oth an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _-.:_.. . .......... DATE - -- -_- BUILDING PERMIT ISSUED -------------------------- -----_-- .......-DATE ---........................................ ADD#TIONAL COMMENTS ....----------------------------- ------------------------------------- ---- ------------ ------------------------ --- ------ -•-------------•------•--•---------••-------------------•---- -----------_..--------•------------.._-...._..._---------•----------•- -- _...... ------ ..................... Final Inspection by: �"st --------- ----------------•--_-•...-----•-- ....__Date .. ........ EH �•. 13 24 1-68 • 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M