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. ArrLIF;AIIVN FOR 5ANITATiOP1 PERMIT .............................................. Permit No. (Complete in Triplicate) .......................... This Permit Expires I Year From Date Issued Date Issued Id-/-S 17 Ir -..•,�G 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 ANO./59 and existing Rules and Regulations, JOB ADDRESS/LOCATI 2,�! .. L�Fst �'c!.../�l5 A.V.! ...............CENSUS TRACT .......................... Owner's Name Wit! ......................... Phone ...................................... Address _.-._ /J . City .`..._ .. �- J r ......---._......... Phone . '.x?- ..... Contractor's Name ... ..................................License # Installation will serval Rence Apartment House❑ Commercial ❑Traller Court � Motel ❑Other . [ Number of living units: . Number of.bedrooms �J.----Garbage Grinder ....--.. Lot Size ............................................ Water Supply: Public System and name ................. .,t_...---•--.............._..._----------------• Private a— .... Character of soil to a depth of 3,feet:_._.Sand 0 Silt❑ -ICIOV--CIO _❑ Peat[j Siandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ ill Matertal ... If yes,type............... ............ (Plot plan, showing size of lot, Iocati `n o&syCt-9rW•1n.relat1on.to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seeP,age plt perthltled If public sewer is available within 200 feet,) PACKAGE TREATMENT; ( J $EPTIC-TANK[ Size. Liquid Depth .............._-......... LL. Capacity a . � 7lMaterial\ .. No Compartments J.-.�......... � Distance to nearest: Well .Ip4 =..�:: : rtauruJg9ft on .. � Prop. Line ....... ----- ____ LEACHING LINEt...................../ .. [ J No. of Lines -`,,✓............. ..... Length of ads I ne...��. Total Length �....................J 'D' Box ...I....... Type Filter Materialpt ..� ...De h Filter Material .-.�..11 ......................._..... 6 Distance to nearest: Well ........................ oundation Property Line ........................V SEEPAGE PIT [ ) Depth .................... Diameter ................ Number :.... ...................... Rock Filled Yes ❑ No (3 . Water Table Depth .... ..... ...RocckSize ............................... _ �✓ ; Distance,tlL.nearastc Weil., .., . , Nr;, ..FoUt atlon .................... Prop. Line ........._...--.....� REPAIR/ADDITION(Prov. Sanitation Permit# .............. _.,.__pc7te{........:..............._......... ) Septic Tank (Specify Requirementsl ..............................:.............................................._....__.................................................. � Disposal Field (Specify Requirements) .........._............_.................... ........... .................... .......:...................•---•-------••----..........................................._.......••------......................................._......................•-• — ------------------------ - - -------------------------------------------------- -------------------......_-----------------------------------,....................................................... (Draw existing and required addition on reverse side) 1 hereby certify that 1 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. 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 becom subject to W n's Comp cation laws of California." � Signed ... ...... . -- ----- Owner By ..................................................................................................... . Title . ....._ .......... _............... ..... ..... (If other than owner( FO&RIPARTMENT US LY APPLICATION ACCEPTED BY .... . . ................... DATE .. :... ....- BUILDING PERMIT ISSUED ........................... . .......................... ...DATE ...................:....................... .. ADDITIONAL COMMENTS ......._._....... --•......................--......... . --- .......................... ................................... ...................................................................... ............................................ ..................... . ....................... ........................... .................. .....------.....................................: _ .. ....... . .... ........................- ! Final Inspection b ...... .. .. ............Data .- ... ..... ..: EH 13 2h 1-68 &v. 5M SAN J AQUIN LOCAL HEALTH DISTRICT 8/711 311