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APPLICATION FOR SANITATION PERMIT ......... Permit (Complete In triplicate! � )] ..............~......................................... ..................................... This Permit Expires I' Year From Elate Issued Date issued ..5=-�".7� 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+ JOB ADDRESSAOCATION � ................CENSUS TRACT .......................... �q Owner's Name ....00.tt'>'1....... .... .. rr121J.+-....................................................... ......'...............-Phone 41... 0.xx.................... Address _...._.._...0...... .. City ............ . ..... It . Contractor's Name ......`!----...-.-..----------------•--•--.------•--------------------- i nse # ............-ti...�_�P�hon w%0 ...... .._ it Installation will serveh Residence 0 Apartment House Co 4F]Traller Court 0 Motel j]Other---••---------- --••--------------- Number of living units:------------ Number of bedrooms ............Garbage Grinder ............ Lot Size -hVA............................ Water Supply: Public System and name --------------------------------------------------------........--..........................................Private ] Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay M Peat 0 Sandy Loam Z Clay Loam 0 Hardpan 0 Adobe 0 Fill Material ............If yes,type ............... ............ (Plot plan, showing size of lot, location of system 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 204 feet,) , , PACKAGE TREATMENT [ } SEPTIC TANK Q•} Size_...�lQ fi_�......................... Liquid Depth �A.................. Capacity .. .......... Type _ -- Material---ll*a�e.7105- ------ No. Compartments .. ............... • ..... Prop. Line k9 Distance to nearest: Well ----�%�._....-•.................Foundation ..�------..._. .. .-.:+...--... .EACHING LINE jp No. of Lines .. ............. ---. Length of each line...-1.................. Total Length .. 1?_ .................A •D• Box -IW..... Type Filter Material ../Q& ......Depth Filter Material .A9.............................._....,_ Distance to nearest. Well ...Zlg�............... Foundation -7�................ Property Line 47!f............... SEEPAGE PIT [ } Depth .................... Diameter ................ Number ............................ Rock Filled Yes 0 No ❑E , t Water 'Table Depth .--••...........................................Rock Size ................................ Distance to nearest: Well ........................................Foundation ..................... Prop. Lips ...........----.--•- REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. ^_Septic Tank (Specify Requirements) ------•.................................. ... . ..................................................._.._. I........................... , Disposal Field (Specify Requirements) -------------------------------------------------...................... ........................................................ ------- ......................................... ...---------•...•.........................•------••-•-••-•--------.....----••-•--------•--•.......------...------•......------•-•--------•---•--.......-----..........------...-----------•-••------•--• (Draw,existing and required addition on reverse side) I hereby codify 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: "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 b7to subje to o an's Compensation.laws of California." Signed . . .. -. .... " -F'` � •..e................... Owner By ........................................... Jitle .......-:--................................----......................... (If other than o par) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - �6 1` ............... ----------------•-•�-•----..............................-----...-.. DATE .�'.. BUILDING PERMIT ISSUED ..............•--.........:............................... ....... ...................-•---.... -• ....DATE-- .-...................................... ADDITIONAL COMMENTS .- ------ - Final Inspection by: Date . ...-7 M, 13 2h 1-68 Rev. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M