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FOR OFFICE USE: a + APPLICATION FOR SANITATION PERMIT (Complete in TrJpflcatel Permit No. ......_�'� E .............. _ .. Date Issued . This Permit Expires 1 Year From Date Issued 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 Count Ordinance No. 549 'and and existing Rules and Regulptionst 'JOS ADDRESS/LOCATION .._......_,_ ?._ _ - ._- s�=.�: •-- .. .•, ...CENSUS TRACT ...............I.......... Owner's Name ........ -c �_..._... ��.............. '.._...__..._._........ Phone Address ................. __..._..�,.. �------- ........ Ci - . Contractor's Name ...License # J,( ---. Phone �LP .... ,Installation will serve: Residence jXApartment Houseo Commercial oTra€ler Court Motel ❑Other ��L Number of living units:_____ ___ Number of betdrooms --rbage Grin' ... Lot Size __ --�_ . - ------ .......... Water Supply:-Public-System and lame-_-------------------------- ------- —.- - -------------••--•---- -------- ---Private [] Character of soil to a depth of 3 fee — l: Sand❑ Silt❑ Clay 0 Peat❑ Sandy Loam ❑ Clay Loam i 4 Hardpan 0-- J ;LQb fill_Mater_ial.....------•--_#f yes,=tYpe- ...... ...... C tl (Piot plan, showing size of-plot, location of system in relation to wells, buildings, etc. mustibe placed on reverse side.) NEW INSTALLATION: (No septic.itank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f �. .SEPTIC TANK I ]2�Yfy�1'`ll�ize--------------------------------------------..__ liquid Depth ............... ' t Capacity) --------- --------- Type -------_---------- Material------------ : ---- No. k Com ortments p In Distance to nearest: Well ---------------------•--------------Foundation -----------•---_---- Prop. tine .................... t / t LEACHING LINE No. of-Line Length of eachine- % ...------ To#al Length ............ . Uj 'D':Box . Type Filter Material _ �i Yp -----Depth Filter Material _.f, ....._.......:...........-........ a Distanc�o nearest: Welt �`_4c (..__ Foundation .l�f................ Property Line • -5 ............... I J� SE€PAGE PIT ,: Depth`��---_--- Diameter '-r.vv.s� Number _r...l_=�"--_........ Rock Filled Yes�' No !] C Water�Table Depth .....::...... -..Rock/Size 't P Distance o nearest: Well _ Q-A, e, ----_-------Foundation _A- -------- Pro Line ---��-.......... 9 REPAIR/A60ITFION(Prev. Sonitaton Permit# --------------------- --------------- ---- Date ...............---_----------_-- Septic --••------ --_-•Septic T6hk (Specify.Requiremignts) ........................ ...r. . Disposaf Field (Specify Requirements) .. ------------ ----------------- -__._1______ ________ k t .__._.._ ............... .............................. t � �f (Draw existing and rWgttfrecLadd tion`on reverse side) I"- .. f 1 hereby certify#liafrf�aveprepared•r�this�appEiration atid�-fh�ut�-the�work�will 6e done in accordance with San Joaquin County Qrd€nances,�'State,.law(,�an Ci6lfes-cendyE Mations of the San 3o64u€n Local Health bJstriel. Hoene owner or licen- sed agents signature certifies the following: "1 certifythat in the —p i. performance•-af-the-wo-t for which this permit is issued, I shall not employ anylperson in such manner us to become subj ft)to4crkman's Compensation laws of California." Signed --- -� -- Owner - . -- ----=-- ----•- Y ....__. /y�.�'.-� s� .._'_. Title ... f t Lf other than owner { a FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY ---- 1..._--- .... DATE ,;.BUILDING PERMIT-4SSUED-.---.i. -:o._ --..,, �� -� _ DATE^'_,...r� " �- --- -----------... . ....... . ..-_ ._..----- ADDITIONAL_ COMMENTS �. , ,�. ---, ............................. .� .+�...... � _ -saner —.w .......r ............................. ..-- -...----'----------------------------------------------------------------- -----------•_•_•__. .. _ ..._...._..._.., -. by: .- ... - -------Date - ,� EH 13 24 1--68 v. Fina! ,Inspectioni SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M i f