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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .....:. ... ................. Permit No 1Compleh to Triplicot .e) " .................................................... This Permit Expires 1 Year From Date Issued Date Issued -r��'Ta` 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 ADDRESS/LOCAqTION .- SLA l.S. ......------...........................-----..........._............CENSUS TRACT ................. Owner's Name .._.A _g...h_.E - .............Phonea� _0 , Address - .....Z-101.._.�_ A5;!t....R1)......................................_...._ G t4C ci Contractor's Name -•----�:?S'in.1L:1L= •-.............-------.........--------::..---...license # Phone ............................. Installation will serve: Residence Q'�(Partment House❑ Commercial❑Trailer Court I] Motel ❑Other................................ _ ---__ /� Number of living units:..... ----- Number of bedrooms ..... ...-.Garbo a Grinder .PP... Lot Size ...../..................................... Water Supply: Public System and name -. .Private [}— Character of soil too depth of 3 feet: Sand Q�Silt❑ Clay El Pee PeSandy Loom Clay loam � Hardpan❑ Adobe t] 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 200 feet,) Q PACKAGE TREATMENT ( I SEPTIC TANK T j Size........................._..._......._. . Liquid Depth po Capacity ............._ .... Type - ------........... Material........ -............ No. Compartments ..................... .S Distance to"nearest: Well ....................................Foundation ...................... Prop. Line .............:.,..__.. LEACHING LINE [ ] No. of Lines ........................ Length of each line......------................ Total Length 'D' Box .......-... Type Filter Materia( ....................Depth Filter Material ............................................ I 'Distance to nearesf: Well ................. .. Foundation ........................ ProperFy Line" ..............:.... ' SEEPAGE PIT [ ) Depth .................... Diameter .................. Number ............................ Rock Filled Yes ❑ No 0 Water Table Depth ................................................Rock Size ....................------------ Distance to nearest: Well .. ...................................Foundation .................... Prop. Line ........._........... REPAIR/ADDITION(Prev. Sanitation Permit# ........... Date ._.......t.......................) Septic Tank (Specify Requirements) ....:...... 1.20.0 -•---......................................-............................... ` \ Disposal Field (Specify Requirements) .......Lo......�CC25 @ _.1 !2....................................... --.------............................ . ................... ...........------------.......... -----------•---..-......... ........_....--------....-•-•-•---------------...-•--.___.....•......._I....._..........-•---.....--- ................. ... (( (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 Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certi 'es the following: "I certify that ' ! p ormance of a for which this permit is issued, 1 shall not employ any person in such manner as to become ie s Comp sation laws o California." Signed. ... .. /1. ��r _ _. _-- Owner By --------------------------- .......................................... _ Title ........................ ............- (If other than owner) FOR . PARTMENT USE ONLY APPLICATION ACCEPTED BY...._._. ... . - ----••- ----------.... ..........•---....-----------............------. DATE ..�--Oo--�--•-•---------------------- BUILDING PERMIT ISSUED--....... .. ............ ADDITIONALCOMMENTS.........------ - ............._...:' --.............. ......................----•------•--•- •---..._....... ^-......................... ---...--................................._........._....-- ---•-------................-------•-•-----------••-------------------------- • ..... - .................................. ..... _.... - .................................__................... --- ------.............. ............... ............. ............ .. ......------=•....................................---..........._.........fit f P/ FinalInspection by; ............. - ••---...------.........................------------....---•--.Date...-! � F.b..---............. SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1•'68 Rev. SM.