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" `-Z�FOP, OFFICE USE: :..... APPLIC,kTION FOR. ,SANITATION PERMIT (Complete Triplicate) Permit No. .y .. p p .............•--..••.........._......-- •----- _ r This Perrnitfxpires 1 Year from Date Issued Dane Issued Application is hereby made to the San Joa uin Local Health District for a I z q permit to construct and Instal) the work herein ;I described. This application is made in compliance with County-Ordinance_No..549..ancl exi ti Rules.and Regulations: JOB ADDRESS/LOCATION `.... _.. _....CENSUS TRACT ...:... Owner's Name .......... ¢ �,y'pr�/ n .8�...... ............................!� Address ._�..-�_�,��..� � �?�.H, •---•-•..... ........... ........... .. ------ _..�� _._. ...._ ...............:......................... City ... � s Contractor's Name License �# A 'S` .- Phone Installation will serve: ` ' Residence Ap artment House Commercial ' O.Apartment 1] ❑Trailer Court �� Motel ❑Other.................. Number of•living units:.... Number of!edrooms S,------Garbage Grinder .......___ Lot Size ................. Water Supply: Public System and name ............. Private ❑ ........:........ •-•--------.....------....-••.........-• .......... t Character of soil to a depth of 3 teat: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan (] Adobe,❑ Fill Material if yes,tYPa � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse -side.1'J[ l NEW INSTALLATION: INo septic tank or seep a pit permitted if public sewer is available within 200 feet,l PACKAGE TREATMENT j ] SEPTIC TANK{ Size. Liquid depth �.. Capacity IA�-.---• Typea �_ Material..1 - Na. Compartments � ,,,Distance to nearest: Well ....... J�.Y................Foundation ._lf............... Prop. Line . LEACHING LINE No. of Lines ...�-------------=- Length of each line......... Total Length f D' Box --.. Type Fi1ter'Mdteri-0l40xa..Depth Filter Material ................................ Distance to�nearest: Well __x:75:_.. ....... Foundation _._��....... J .._... Property line ........................ SEEPAGE PIT 1 ( J Depth .__... .............. Diameter�.............. Number _•---....------....:........ Rock Filled Yes ❑ No Water TableDepth " � t `••�`----•--•------••---:.._._Rock Size ....-------•-•- ---------------- Distance to nearest: Well ..................Foundation ............. Prop. Line € REPAIR/ADDITION(Prev. Sdnitation�Perm It# ......_..__F.................. ....'..:___-- Date ............._...................... l . Septic Tank (Specify Requirements).................,--------........... ............--.........................,............-_............................................................ Disposal Field (Specify Requirementsl ....................:................ .._ --------•------••-•--------•..............•---...--•-•------------ ....-••-----•- . r } (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 Son Joaquin Local HQalth:District. Home owner or licen- sed agents signature certifies the following: f "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 beta subject t Wo an's Compensation laws of California." Signed k " , -- - ----- - --- �+�.-�•:�------------=-----•--••-- Owner BY ------------- `l . Title _.. C,42 (if other than ownerl _ .....__... .... -------- ---------- FOR -- --- FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___-• DATE .....C7. .�j►_._:'-�...-_-•-�-: - ---•- BUIEflING PERMIT 155UED - ----------------- ADDITIONAL ... ..............:... .•--------- -----------------._.DATE ....--• --- ... - ---....-------------- BUILDING ---•---- -- ADDITIONAL COMMENTS ----- l ..........................I................................. ---- Final Inspection by. ,....__.... _ .......... EH ............ -•-••-• ...................................Date .... 13 2h 1-68 Rev. 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M f