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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT {Complete in Triplicate} Permit No. .................. ........ ........................ this Perr»ItSxpires 1 YearFrom Dandswed 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: OB ADDRESS/LOCATION .-...4267 -fir. burner..,}.,P.,.............................. ...CENSUS TRACT .,Lod. .............. Owner's Name -_L0uiS,:: Selles Phone .3-6 .44. ---..... -----i..........- Address Same ................. City Contractor's Name ---Tank...Ssr................ ...............License # .3a.-57..-21... Phone .3.yRi343.. Installation will serve: Residence• Apartment Housefl Commercial ❑Trailer Court 0 Motel ❑Other �.-a-..-.., ...� .-.� Number'of living units:-------- Number of bedrooms ...2......_Garbage Grinder ...Ti•Q ... Lot Size ................. Water Supply: 1 ............ pp y P ublic System and name --•••• ---------•----• .........:................_ ...................................................................Private J r Character of soil too depth of 3 feet: Sand❑ Silt 0 Clay ❑ Peat❑ Sandy Loam. , Clay Loam ❑ r Hardpan E] AdobeQ Fill Materlal If yes,type ............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.] NEW INSTALLATION: (No septic tank or seepage pit permitted if public.sewer is available within 200 feet,] PACKAGE TREATMENT' .[ ] SEPTIC TANK f ] Size_................... f � =Liquid Depth ...:...:.......... Capacity ---------------___ Type ...--•---_-----..; Material--_.-__--- -- No. Compartments Distance to nearest: Well ....................................Foundation Pro Line ................... p. ............... LEACHING LINE ( ] No. of Lines --------------. Length of each line............................ Total length 'D' Box .----------- Type Filter Material ....................Depth .Filter Material ..................... ,_.._Distance to nearest: Well _--------_------- ... Foundation ........................ Property Line ....... ................ . ,r SEEPAGE PIT [ ] Depth- 7-7.1..... Diameter ................ Number ..............................__. Rock Filled Yes ❑ No C] Water Table Depth ------------------ ................:..Rock Size .....---.....---_..... ., F ` '!!!, Distance tontearest: Well .................. Foundation --------- . --• ---------------- Prop. Line ...... ........... REPAIR/ADDITION(Prev. Sanitation-Permit-`# ............................................. Date -- - Se tic Tank S eci Re uirements "^ R Disposal Fielci .(Specify Requirements)^ 8Q�_.:A 1 ea� -.],1T1 an„• � 9i:lfi£' ¢f..1 line an little house'; in `back -------- --------------•------------------•--- ---- • 1( _. ----- (Draw existing.and-required-addition°on reverse-side)6 ` I hereby certify that 1 have prepared this application and that the walk will be-done in accordance with San Joaquin County Ordinances, State Laws,,,6d Rules and Regulations aE the.San Joaquin Local Health,District. Home owner or Been- sed agents signature certifies the following: "I certify that in the perfotmance of:the work forwhich Ibis permit is Issued;1 shall not-employ any.person In such manner as to become subject to Workman' Lorre ensation laws of California.” Signed Owner n ------------- By .__._ ----- Title _Crier- G._. -. +.Se .t �_ .m n f other than owner] - Sir FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _.--__ . .- ._ .- ------- --................ DATE BUILDING PERMIT ISSUED "-----...:-- -_. ,- DATE ..: - --- ADDITIONAL COMMENTS -------------------------- -------------------- ------- --------- :- ----- •--- --------------------•---------- ------ ---.>...--------_----- ---... -----...._...---...._.....------------.........._..-----............. -----------------------•--•------•- Y final inspection by: - -- --------Date ... .. -7G.. Eli 13 24 1-68 ibev' 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M i