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FOR OFFICE USE: APPILICAT10N FOR SANITATION PERMIT . .......-_------- •................. , J" I Kermit No. ................. l Y (Complete in Triplicate) ' • . This Permit Expires 1 Year From Date Issuer! Date Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. This application;sbmade in.'coirfp lance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO ATION �l..ip{ll_77. � '�.......:.;... :........ .:...' ..!CENSUS TRA CE ( -. .n.l......... Owner's Nome . --. .!4 •�:. / I ._...........................................' ..:........:......... Phone ' � .� Address ... ..l ilk(D.Z I ._...!`-:..�?..R� i f- ..__... v._.:�.......... City ...._r?, �j ............ ...... n .... Contractor's Name}. �_ __-SeA-Axs .,...:-AA3/. 'Sem..................License # S7'Z........phone- . V..`37.+3„ .. Installation will serve: i i2esidenceimpartment Houseo Commercial [:]Trailer Court Motel ❑Other ........................ { � w Number of living., units:.. r_----- Number of bedrooms � ..Garbage Grinder ............ Lot Size �'J I j �- Water Supply. Public System and name -------•-- ...........................-----.....•--....................... ..............Private ❑ Characfer of,soil to a depth of 3.feet: Sand❑ Silt❑ Clay ❑/Peat❑ Sandy Loam_0,*`,Clay Loam ❑ `� ' Hardpan__3—Adobe 0Fill Material If yes,type ............... ............ v] (Plot plana-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 p t .permitted if public sewer is available within 200 feet,} N -PACKAGE TREATMENT [ l SEPTIC TANK{ Size................................................ Liquid Depth .......................... 4. t Capacity T pe .................... Material................. . No. Compartments R .t i Distance to nearest'Weli Foundation Prop. Line •............ .................... .................. LEACHING LINE [ No. of Lines ...... .f............. Length of each line................. .. Total Length 'D' Box -------------- Type Filter Material ....................Depth .Filter Material ........................................... Distance to.nearest: Well --- ---------------:- Foundation ........._..... -------- Property Line ........................ SEEPAGE'PIT Depth Diameter ................ Number ............................ frock Filled Yes [3 No C1 Water Table Depth -•--=------------------------•- -- .----.....Rock Size ---. ........................... . ----a---..Distance to nearest: Well ______________.-.._...___..-E....___..Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ....•---------------------------------=..... Date ..._...... .................. 3 Septic Tank (Specify Requirements). ---_- !.. ---------------I - -----------I ............................ .......... :_..._......... ....................... Disposal Field (Specify Requirements) -------------- -------- -------�1--- - ---�/- d ---.-----_- --- O---------:9... u' -------------------------•----------------..._..._..................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with Son Joaquin County Ordinancos, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. 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 as to become sub ect to Workman's Compensation laws of California." Signed ...... Owner I ------ Title .�h(Jr.._.^ � � iCCT— BY ! -. ... i {I otlier than..owner}— _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.(.'-dDATE .Z. .... BUILDING PERMIT ISSUED _..--------- __-0._q---------------------------------------------------- --------------------....---DATE _-- ......... ADDITIONALCOMMENTS ----- --------------------------- -------------------------------------- ------=-----• --------------------- ----- -----...............................--_... ....----- ------------------------- ------------------------------•-•-•-- ---- --------------------------------------•------------------------------ ----.........----------..._................_....._ - ----- ---- • - - Final Inspection by: - ---------- Date -S•--•• �' EH �3 2L 1-68 1_,v• SAN JOAQUIN LOCAL'YHEALTH Dl5TI2ICT 8/7[t 3N