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FOR OFFICE-USE: APPLICATION FOR SANITATION PERMIT �. Y (Complete["'Triplicate) mit No. _.,. .... ... .. . This Permit Expires 1 Year From Date Issued date Issued ... --. 1 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 Rulei_-ant! ReGfulations: 14 Q JOB ADDRESS/LOCATIC#N .......•�} -p- ''� ".. :',: 0.3.4.. .... °. ...._....... CENSUS TRACT_.....'.. ...... l Owner's Name ... 1. �.�'`� ... .11e/t?/ ...................Phone ........... Address .... City �..S.G'. - ' Contractor's Name ------ .............................................................License # .........*.............. Phone ....f.......................... .'. Installation will serve: Residence❑Apartment House Commercial ❑Troller Court 0 1 i Motel ❑Other ............................................ Number of living units:--. ----- Number of bedrooms :.......Garbage Grinder .........:.. Lot Size . ..:-.i........................' Water Supply: Public System and name -• ••• ❑ { Character of soil to a depth of 3 feet: Sand E] Silt❑ Goy ❑ Peat❑ Sandy Loam [J Clay Loam Hardpan Adobe 0 Fill Material ............ If yes,type ............... .........�.. 1 r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed -on teverse side.J NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE TREATMENT { ] SEPTIC TANK Size__./ �` '�`.................... ....... Liquid Depth T-- '---........ -_. ; Capacity .la-®�_-.-.- Typ42--4 .&,!r__ Mater.ial...filflYt..,.... No. Compartments .. '�.�........... 60 ,4 Distance to'nearest: Well .....__- ...Foundation ... ........ Prop. Lir ... LEACHING LINE No. of Lines ---u2------------------- Length offfeach line._---�..�9----....._.. Total Length .,�J.��?...'....-.:....,. 'D' Box ..... Type Filter Material/.""_�3_..........Depth .Filter Material .19_11................................ ' Distance to nearest: Well ••------.- Foundation .l:p.F............. Property Line + l ......0 SEI PAGE PIT Depth ......... Diameter 3 `' ... Number -'------;.- Rock Filled Yes—dR No Water Table Depth ..._ ......................... Size .................. Distance to nearest: Well ....•........................Foundation 14 Prop. Line ..ter..._......... . REPAIVADDITION(Prev. Sanitation Permit{# --------.----------------.........•--. . Date ...........'°`�---.........._-__] - s .� •r • Septic Tank (Specify Requirements) Disposal—Field (Specify Requirements) ................................. f ------------------------ {Draw existing and required addition''on reverse aide)I `' I hereby certify that I have prepared this application and that the work will..be done.in accordance with San Joaquin i' County Ordinances, State Laws, and Rules and Regulations of the Son loagvin Local Health,Dlstrict. Home owner or licen- $ad agents signature certifies the following: "I certify that in.the performance of the work for 'which this permit Is issued, t shalf.Ztiiiary'any person in such manner as to become subject to Workman's Compensations laws of California." Signed - - - a'`"" • `.�-� ...-----••--- Owner .. ` BY -- Jitle ` :.. (if other than owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - •--------••----------------- -. DATE . ._-....... _. _ f BUILDING PERMIT ISSUED ---.............-------------------------------------------�-------.---------------........................DATE ............_...-----•--•-� -•-= ----••--- ADDITIONALCOMMENTS -------------------------------------------------------------------------------------- .......----------------........................--------.-. --- ---------------- -----------------•---------- ------------------- ....................... --------------....... ... ................-----•-- ................ ,Y ..........................:...----..----------....... -......................... k -----------------------•---------e ---•-------- __�..-...._......_ ..---------•-•--------...........-- . .. fes/ ....._............ Final Inspection by. =' -!�.... ?` Date�f t�f /.'. ................ Z ��r. EH 13 2L 1'68 C__v 5M SAN JOAO IN LOCAL HEALTH DISTRICT 8/7h 3M f ,