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. I'PLICAT#ON FOR SANITATION PET (Complete in Triplicate) Permit No. ..... 7� ----•--------••------ Date Issued Doti Issued--------�4.--. This Permit Expires 1 Year from Date Issued _ -- �a. C i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application.1s made in compliance with unty Ordinance No. 5.49 and existing Rules and Regulotions: JOS ADDRESS/L TION �I -� ..... :.z ti..-...:..... -• CENSUS TRACT .................... Owner's Name �'� •. ... . ---..... -•...............•-�....I.---................:................Phone . p ._..._ Address . ----••---�1.- -�.:. -...-- -City .......... - i � . ` - ......- ._.License JL......�.1.__ Phone .. .. .r" ... Contractor's Name Installation will serve: �! Residenceariment Nouse t] Commercial flTrailer Court Motel ❑Other Number of living units---- ----- Number of bedrooms -.-3_---.Garbage Grinder� Lot Size ............ � Water Supply: Public System�i"and name ..................................Private .---•--•----------- -•--------.............................. ........- Character of soil to a depth of 3 feet: Sand O Silt[Q pay [3 Peot❑ Sandy Loam.❑ Clay Loam o Hardpan p Adobe 0 Fill Material ............If Yes,hiPe--•............ ............ , (Plot plan, showing size of:lot, location of syste ' -in relation to wells, buildings; etc. must be placed on reverse side.) NEW INSTALLATION: I .� {No"septic tank or seepage`pitr.permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] i SEPTIC TAMC ] ---•---•...............................•---..... Liquid. Depth ................... . I Capacity P tY Type ._... Material----------------••-.._ No. Compartments .................-:." Distance to nearest: Well _....•.............:................Foundation ...................... Prop. Line ................... LEACHING LINE [ ]. No.,of Lines ---------------------_ Length of each lime...._--.._.._.............._ Total Length ..........................:.v1 Box ........... Type Filter Materia! . . ..... ........_- Depth .Filter Material ............................... . Distance to nearest: Well ------•---••---. ....... foundation ------------------------ Property Line ........................00"C SEEPAGE - P.M PIT [ I Depth ------------------_ Diameter ..................Number .......___.... ........... Rock Filled Yea 0 No Water Table Depth ---•...:..............•.Rock Size ................................ Distance to nearest: Well .......................................Foundation .................... Prop. Una ...................... REPAIR/ADDITION(Prey. Sanitation Permit# ................................... .:-- Date ..................... Septic Tank (Specify Requirements) :.............._... . :.._w Disposal eid (S city Requirements) L� ---- . ........ ... .. . ------------,, !f ---------------------------------------- ------------------------•--•------------------------•---- ._......_._..---------------------•-•---• ----------------•-•----•-------- .-•-...--•••......... (Draw existing and required addition on reverse side) I .hereby certify that I"have'�prepared this application and that the work will be done In accordance with San Joaquin" County Ordinances, State Ltws, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or Ikon- sed agents signature certifies the followings "I certify that in the performance of the work for which this permit is Issued,"1 shall not employ any person in such manner " as to became sub)es to Workman's Compensation laws of California.! Signed......_ ------ ---- • ------ -j-.. Owner BY = Title ----- -�._. I er than owner) I� FOR DEPARTMENT .USE ONLY ` APPLICATION ACCEPTED BY ...... -- DATE --_-_--- ................................ BUILDING PERMIT ISSUED 'M --- DATE ... - - --- •..... ..........•--..... .._. ADDITIONAL CO ME �' - .......... ................ : `: ': .�--- ----------------- -----• ....... ----- ----------------------------------- ---- - . . . ---- Fina Inspection by: ..-. - Date ..... .-. EH 13 2L 1-68 lav• SAN JOAQUIN ROCAL HEARTH DISTRICT 8/7h 3M