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>f FOR OFFICE USE. f APPLICATION FOR SANITATION PERMIT ................... 1 . . (complete In Triplicate) Permit No, ..... .......................................... _....:... ._._. This Permit Expires t Year From DahIssue d Date Issued t Application is hereby mode to the Son Joaquin Local Health District for a permit to constrict and Install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..,�................................._,_CENSUS .....__...... Owner's Name ...... �.7cne4x sr. Address ._. 8 �,t'. i9 'r ' C Phan ... Contractor's Name . / � �. .5:1+_+�C��:L c l `__.^+ Liclari i.1�'J.1-74 �Phom .......--_. •...... Installation will serve: Residgrce Apartment Hovse.{J_Comniereibl{)Trailer=Court NCotel❑Other°._�......... ;t Number of living units:..._._._ Number of bedrooms, _.J.--Garbage bage Grinder ............ Lot Size t:.:............. Water Supply: Public System and name ______________ v . Pri ate Character of soil to a depth of 3 feet: Sand❑ Silt o Clay O Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan❑ Adobe L3 Fill Materlcl if yes,type........................... ' •••--•...... (Plot plan, showing size of lot, location}of system In relation to wells, buildings, etc. must be placed onreverse aide.}`�, -__.0 NEW INSTALLATION: (No septic tank or seepage tAt permitted if public sewed is available within.20a-feet;(' PACKAGE TREATMENT [ 3`SEPTIC TANK i j Axl a>Lt + �. Size.'................•--•-•..........:---_. ... Liquid Depth ._..................... _ Capacity .dE'Q4......... Type -AQa . Material..�Gt1 No. C.orrhpartments ..:�......---_-- i Distance.to nearest: Well ' --------------Foundation Prop. Line . LEACH) VE [ j No. of Lines ......................... Length of eachline............................ Total Length D'; Sox ... ....... Type Filter Material ....................Depth Filter Material �i �..�.--._+ :.:Distance to nearest: Well •---..... Foundation ........................... .................. �•.�.-� ----�-�---:..'....----•-Y Property line ............. .... 1 SEEPAGE P1T [ } Depth Diameter ..._._.._.�.-_.- Number -------------- -_-- Rock Filled Yes ❑ No [] Water Table Depth ...................... ...........----.Rock Size ..................-....... . 'Distance to nearest: Well ........................................Foundation .................... Prop. Llne ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ------------------------......... I Septic Tank (Specify Requirements)) ...:.............. .....__. ...._. -...........................` --••---------- .._--._ . Disposal Field (Specify Requirementsl %0__ cs/�•, �s�w____�L . $X/.ta._ -.J'H_ �__.__- ........................................----------_-- fi d/�.. ----------------•-•-••--........ ........................................................... . ................... (Draw existing and required a itian on re rse s1del 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.DlsMd. Hayne owner or licen- sed agents signature certifies the following: "! 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 subject to Workman's Compensation laws.,iif California." ,_1 Signed . ------ --- ---------- -_ ..------ Owner BY -- ------------------------ ---•----- = - ..... Jitte ......................... (If other than owner) . _ FOR XPARTMENT USE ONLY APPLICATION ACCEPTED BY------ .. . ....................... DATE ...... ... .-Z.`_.�-------.-_-: BUILDING PERMIT ISSUED ...............:....... DATE ........................................... ADDITIONAL COMMENTS ......____L.... ... ........................................................................ ..------•-- .. ...... ............................_...-••-•--••-•.._......••--.-- .-----.---................... . Final ins action b - - - - P Y' -------------------------------------------------------- Date ,G... EH 13 2h 1-66 Re SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7h 3M