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FOR OFFICE USE: f APPLICATION FOR SANITATION PERMIT ................:......................1.1.......... (Cornplate.in firs litate) Permit No. ..... . SSG. ............. This Permit Expires 1 Year Front Date lsssted ate Issued --6--•° /.7.� I Application is hereby made to the San .Joaquin Local Health District for a permit to construct and install the work herein escr dibed. This application is made in compliance w€th reounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO ........jX�v ...._.. �G!� ... ....... . ................. .. -. •- CENSUS TRACr ...........................Owner's Name Address -- -••--.-•• Phone ........... ..•. ... - � ..... C •.............City .....cam- ...... Contractor's Name _, '.----- -- nse ZZ ...lice �� Ph �. e .- Installation will serve: r Residence partment'House❑-ComnietaJoI ]Trailer Court,E] a f Motel ❑Other ...........:...•---....._. Number of living units•_ Number of iaedr s Garbo a Grinder 't lot : ...... .�•- •----•---- -•-�- .._. ...................Size` / -.a.. ..Water Supply' Public System and name .........................Private .-- ❑ Character of sail to a depth of a feet: Sand Slit❑ Clay t E3 Sandy Loam❑ Clay Loom[] Hardpan d Adobe i1l Material _ ..If yes,type................ ............ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed an reverse stile.) NEW iNSTAEEATION: (No septic Rk onor seepage pit permitted"if'Pvblie sewer is available within 2tlp feet, � w „ PACKAGE TREATMENT { I SEPTIC TANK ................. j Liquid Depth ........ Capacity = � . Type Material... No. Com rtm' . pa eats o Distance. to Barest: Well ---... foundation .. ........... - -- ffes...... g.... - Prop.�Une .4. .. °. LEACHING LINE ' No. of line i............... Length f e ch line... ;rTotol Len th D' Box .l f W Type Filter Material -- ..Depth Filter Material tnearest: Well �- ---------- Foundation ... .pistance Property YLine SEEPAGE PIT { Depth ! Diameter 'c^� l ...... ---_ Number ...... ........... Rock Filled ; Yea Water}Table Depth fRock % o�� - Size /Z.. E Distance to.nearest: Well ...... � _ . .. � • --�..............Foundation ._�.d_.�.... Prop. Line ..__.�.. .. REPAIR/ADDlT1ON(Prev. Sanitation. Permit _...__.....__ pate ......_.�... -- ...1 . Septic Tank(Specify Requirements) .fkv- Disposal Field (Specify Requirements) --- ----- ............ ......... E - •---------------•------i..----•---------------------------------------------•=----•-•---- - ••---•-------• ............ ..............._........- ---..... f .... . (Draw existing and required addition on reverse sidel ?. I hereby certify that t 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 Son .Joaquin local Health,,Disidet. Homo owner or liein- sedagents signature certifies the following: "t certify that in the performance of:the work for which thisern to ermit €s Issued, 1 shall not p employ any Person in such� mann:er as to become su 'ect to Workman's Compensation laws; of California." ;9 Signed ............. ... ..... . � Owner 1�1.a BY title ..... _. .��... 3I { Cher than owner) ----- - FOR DEPARTMENT USE ONLY APPLICATI ACCEPTED 8Y __ -# -� ... - • ----Fn9.1��__.... DATE 1 �. BUILDING PERMIT ISSUED ---------------- -- 7 v ----------------•----------.....-•-----......._.............._.._....I..---- •. -DATE _:......ADDITIONAL COMMENTS ........... ...... - ----------------- -------- ---------•---- --•---•-•-•--•--.........._.__..._....._.... ------......-•-- ,..._ ------ .................... ............................................*............ _ _ Final Inspection by: --- - - - _.__......... .�. .. •-- - - 'Dat y � Ell 13 2h 1-68 Rev. 4 a _. ... t SAN JOAQUI ` LOCAL HEALTH DISTRICT 8/711 3M