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APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..� 1� Date Issued - ------- --- -- ---- --------- -_.--, Thls PermltExpires 1 Ywr From DaNlssued 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: r JOB ADDRESS/LOCATI -. va.-L> ...... ....... I ... CENSUS TRACT .- Owner's Name _ . ...Phone . ��.�7... .. '/. . - G c r' Address 71� $4O 5.r !� / ._-._ .-------- City rte-/��_ ._.-. .. Contractor's Name ....._ -_.- - .............._......- -•------ _.. .License # ........................ Phone -.-...... .................... Installation will serve: Residence❑Apartment House❑ Commercial KTrailer Court D Motel ❑Other---- ---. ............... ........ Number of living units,.. --------- Number of bedrooms ............Garbage Grinder ............ Lot Size -..._..� Water Supply: Public System and name .---------------------- -----------------------------------------------Private W Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay R Peat❑ Sandy Loam ❑ lay Loam,•$) Hardpan C] Adobe ❑ Fill Material -.......... If yes,type .. C — (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side' y NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT _ [ ] SEPTIC TANK{ ] Size 7 ... ... . ..__-------__ Liquid Depth _.. .................. Capacity _-.._---------- Type . .. .... -_VT? MaTeri .--- -... . . . No. Compartments ....,.I---` --__-----/------ _ _ _ _ . Distance to nearest: Well -------Foundation -.-. .-. ..._ ..-._ Prop. Line __ ------- LEACHING LINE t Q No. of Lines -- /......__- Length of och li �Q Total Length ------ ........ Irl D' Box .._... ..... Type Filter Material epth Filter Material _..... ..I� --------- r -_ _ Distance to nearest: Wel[ ..._../r7rsS--..___-_ Foundation _.>1.�.......... Property Line -.-_j0-0-c�-.` ,� SEEPAGE PIT ------- Diameter ._ - _. Number ._..--------___...._.. Rock Filled Yes ❑ No ❑ [ l Depth -- _ --- Water Table Depth ------- --- ---------- - Rock Size -------------..----- f ----------- -. . Distance to nearest: Wel[ _:. ...........-.__....Foundation _----------- ------ Prop. Line ..- --..-_- REPAIR/ADDITIONIPrev. Sanitation Permit# .....-------------------- ----------------. Date ..................._-............I Septic Tank (Specify Requirements) -- Disposal Field S -S Odr 2�rrr P ( Pacify Requirements) - ` 1 -..__ — - -- - - - - (Draw existing and required addition on reverse side) 1 hereby certify that i have prepared this application and that the work will he done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hwlth.Dlstdd. Hem* owner or licen- sed agents signature certifies the following: "1 certify that iri he performance of the work for which this permit is issued, I shall not employ any person in such manner cis s to bac -- -- to rkman's Compe�. tio�n aws of California." Signed� - - moi:` - - � � - ---- - ----- ------------._------------ Owner By .... ��- - - -................. Title . -- (i other than owned R PARTMENT 115E ONLY APPLICATION ACCEPTED BY ... - ------------- DATE _11111-776- _._ .....-: BUILDING PERMIT" ISSUED _....--------.DATE - .._. ----- - _...---- - ...._. .... ADDITIONAL COMMENTS . --- - ---- - -- - .........--- - --- --- .----- --------- ------ - ------------ ------------ - -- -- - __ - _ - - Final Inspection by - - - -- .............- Date �l .3- ..�:.`= ... .- ----- . --- ... - ---- EN �3 2h 1-68 Heir. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3m +s