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`---- ... APPLICATION FOR SANITATION PERMIT ................ .... Permit No. __ (Complete in Triplicate) . �S - --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date issued/d- =_2 Application is hereby made to the San Joaquin Local'�Health District for a permit to construct and Install the work herein described. N y Ordinance No. 649 and ex#sting Rules and Regulations: JOBADDRESS/LOCATIO n #s made in com Bance with Count PP � p - y9,_ .............................CENSUS TRACT ...................... Owner's Name ..._.... -- - - . . . ••---- ... ..................:................Phone Address _...... ... .... ... ' - �D... �. - .. rx..... city .. 1 -.. c Contractor's Name .. .. , iS.�.ti r. _w ._ 4.............License # -----....._.. ......... Phone Installation will serve: Residence Apartment House.] Commercial❑Trailer Court 0 Motel a ` Number of living units:._._ Number of bed Dors ..:U_...Garbage Grinder Lot Siza ........_._. Water Supply: Public System and name ------ ... ... } ....-/. ...........Private M . Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam . Hardpan A dobe 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 atvailoble within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------..................••-----••-- Liquid Depth ............•............. •► Capacity -------------------- Type ---------••----: Material.----------------..... No. Compartments ........... Distance to nearest: Well :_ ..Foundation ...................... Prop. Line ......................NP LEACHING LINE [ ]. No. of Lines -----.--_-------------„ Length of each line............................ Total Length Box ............ Type Filter Material ..:.................Depth Filter Material ..._-.____....................................... . Distance to nearest: Well ___: -------------- ! . --- Foundation _....._..---------...... Property Line ._._..._..------.....--; [ 3 P ---- . . .. SEEPAGE PIT Depth r, ..........:..... Number ..___..._..___. ... Rack Filled Yes ❑ No 66_ Water Table Depth -----_-----•- - -.. Rock Size �� -•-•- •---- --- --------•---------------- Distance to nearest: Well ........_:.................................Foundation . Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ---• - o Date ................................... Septic Tank (Specify Requirements). ....._....- ..................... Disposal Fieldecify R quirements) t -------.•.......•------------------------------------- -- r a... --- --------=----------------------------•---------- ................_............... .f_ ______ _ __`•�? -'- ��is Eil' r ______-_ •_.. _........................................ _ (Draw xist g an equired.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 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 become sub'ect tt-��om en tion 1aYws of Cali4oria:” - 1 p Signed - 11 — �:. 1'�;,�7�t� E��µ __._ 4___ _ _ __ _. .. .F � - -I!rl--1 BY --------- ----------- = Title Of other than owner) { R DEPARTMEbl USE ONLY __. APPLICATION ACCEPTED BY _ .__. ------ . ---... DATE �J7G ...... BUILDINGPERMIT ISSUED ------------------- ------ --• ------- = --•-••......----------- ------... .------------.DATE ............................ ........ ---.-----. ---.- --- ADDITIONAL COMMENTS .. - I _ ---------------•• --- ------- --------- ------------------------•---•----- .;. r..: - ------ �i`E y- ..- ----------------------- ---------------- ------------------------------- • ------------- - ----- --- r ----------- - - tinai Inspection b F -•-----•-------------------------------- --Date ..... ....._ _ EH 13 2h 1-68 lfev 5 f SAN J QUIN LOCAL' HEALTH DISTRICT 8/7h 3py