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-- APPLICATION FOR SANITATION PERMIT .......................................... (Complete in Triplicate) Permit No. . ................. ............................... This Permit Expires 1 Year From Date Issued 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 mad//e in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION Owner's Name ---- ef-.-.,-�-.5"�._.L.T. .i.U�.G... _.." . .. 4 ...._. C ElNyS.U...S. TRACT A.C. T 3 ''-... ..f.�. .......,..�... _ ----- �PhoneAddress City Al'4 _�� Contractor's Namei4l. -------------- - ------.License #0`2 .1 . Phone3.1' G�. Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court ;❑ Motel ❑ Other -- ----- umber of living units:----�___-- Number of bedrooms ..QZ-----Garbage Grinder --------- -- Lot Size _- ---_---- Water Supply: Public System and name --_---. --------------------- - -------Private (� Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat[] Sandy Loam IX Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material .._....__._. If es _ Y , type ...... (Plot plan, showing size of lot, location of systerry in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK .+ f ] Size----------------------------------••----•---•--- Liquid Depth ...................- .. .� -- . Capacity ---_--------------- TY 1p ��-------- Material- -------------------_ No. Compartments Distance to nearest: Vl�ell • Ej.�trngth of-------------- Foundation Prop. line .--f-----•------•..... LEACHING LINE [ ] No. of Lines __....-----------� ' __ each line -.---------------------- Total Length I.. 'D' Box ................ Type Filter Material ----.-.-----_---__Depth Filter Material Distance to nearest: Well . _ _ -- . -._-. - ----_--.- {"'""""_"-'• SEEPAGE PIT Foundation Property Line ... Depth ."...... ........... Diameter Number - ...._ - - - Rock Filled Yes (s] No Water Table Depth -- ........................-- ----------------•-Rock Size ........... REPAI to nearest: Well _.._..._.. ;_..._--•._ Foundation ----- Prop. Line ...�------------•- REPAIR/ADDITION(Prev. Sanitation Permit�# _.....__._._..__.�._!-__-_- ./ Septic Tank (Specify Requirements) =' Date ---------------- I l Disposal Field (Specify Requirements) / -C� CZj ...._ ....__�... ..............�........ o.. _-------- - - ............... - - (Draw existing and required addition on reverse side) t ............................................. hereby certify that I 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: q "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such man as to become subj to orkman's Compensation laws of California." -- � manner Signed . - :--- BY ------ Owner - --- -...------------ Title - (If other than owner) FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY _ BUILDING PERMIT ISSUED -.------ /Q-- DATE . _ . -- -- 7 b ADDITIONAL COMMENTS DATE _.................•---•-- -------- ....... .....-------•--- Final Ins ection b _ -- -••--- --•-•--- -- -------------- -•--- •.. . . ._._. . Ell 13 211 1-68 Rev. 5�f - • - --------------Date .._��... _l:b�.--.��4--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M