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FOR OFFICE Wei- APPLICATION u FOR SANITATION PERMIT a .... ............................................. (Complete In Triplicate) Permit No. ................ ....................................................... Ir 1 Year From Date issued Date Issued ..r�..0. � i This Permit Expires { Application is hereby made to the San Joaquin Local Health District for a permit to construct and In:tall the work heroin # described. This application is made 1 omplionce %yith County Ordinance No.,541 and existing Rules and Regulatlonss r JOB ADDRESS LOCATION L. .....CENSUS TRACT`.......................... Owner's Name .. A°� ';� .fir.. ............................................... .....953 3 °..............Phone Address .`�_ . 7-.. �� --..........City .— .... ...... .... Contractor's Name .. �"� 1 7 .. Phone .. �L �..........................................License a,4-' ...�......... Installation will serves idence❑Apartment House[] Commercial❑Trailer Court ❑ i Motel[[Other_t........................................... i Number of living units:............ Number of bedrooms ._.....Garbage Grinder ............ Lot Size ........................:................... Water Supply.. Public System and name ..................................._.._...-_............-- .. .-• ...................Private JVP Character of soil to a.depth of!feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe 0 Fill Material ............ If yes,type j [Plot plan, showing size of.lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) i NEW INSTALLATION: dNo,septic tank or seepage pit permitted if public sewer.Is available within 200fee -tJ -- - PACKAGE TREATMENT [ J SEPTIC TANK[ ) Size..� ..��. .......................... q Depth Capacity .I�'1F1.._?0L_.. Type ...................... No. Compartments _q=.............. Distance to nearest: Well ..Foundation .. Prop. Line . LEACHING LINE [ ) No. of Lines`.- ................. Length of each llne.,! .... Total Length ................014 V.Box J-------- Type Filter Material 4&�54..Depth Filter Material __ ............................::... . , Distance to nearest: Well ................I....... Foundation ........................ Property Line ........................mo i SEEPAGE PIT [ Depth ... Diameter Number .... Rock Filled Yes ❑ No ❑ Water Table Depth ----•---- --•-.•----•-•----•...............••--.Rock Size ................... ............ f Distance to nearest: Well -----•-•................................Foundation ...................... Prop. .Une .._.................. . REPAIR/ADDITION(Prov. Sanitation Permit Date ---..... ....�s� ... .._.[ .. - Septic Tank (Specify Requirements) ......................................... -- ........................_.................................................._....._........ Disposal Field {Specify Requirements) ' ................•--....._..----.........--•---..............._......---•--------•--................._....I.. - (Drow 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. Hone owner or ikon• sed agents signature certifies the following: "I cern that in the performance of the work for which this permit is issued, I shall not employ any person In such manner certify p as to beco a -------- Owner subject to Workman's Compensation laws of California." 4 Signe. . •-------••-•------------ By _. �r t....... . t ................... •---------- yitle .............-.........--................................................ (if ata�an owned ICOR DEPAXTMENT USE ONLY APPLICATION ACCEPTED BY ..........:... ....................................................... DATE .....��`.�... .-:. . _......_ BUILDING, PERMIT ISSUED .....................: .... ....... ...........................................................DATE .............................:...........-. ADDITIONAL COMMENTS _........ ............................................................... ..............:.......................................I.... . ..................................... _.Date Final Inspection by ��..L... �: ...... EH 13 2)e 1-68 Nov. 5m SAN JOAQUIN t, CAL HEALTH DISTRICT '8/7h 3M