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FOR OFFICE USE. APPLICATION. FOR SANITATION PERMIT 9i ! .... -. (Complete in Triplicate) Permit No. i . ......... .. ..... ... ... ... ...... This Permit Expires [ Year From Daft issued Date Issued//.1 .."4.q 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 County Ordnance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION os4�5, 4?....Z7 �/.7.N/T...... '..... CENSUS TRACT S41L.......... Owner's Name , ..... �. �'?�.,. ...Phone Address .. _11* .l.- -� ... .. �I' i'..... City ..... ctr'< C—a-�- z�� ........ . ..................... Contractor's Name ..... .. -c.tlJ License # Phone Installation will serve: Residence Apartment House Commercial ❑Trailer Court C Motel ❑Other �.... .... ...... .............. ...... i . Number of living units: Number of bedrooms .. ...Garbage Grinder .� .... Lot Size . . .......... ......... Water Supply: Public System and name........... .................. .... ;.{.. ...Private Q� f Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat El- Sandy Loam ❑ Clay Loam ❑ I Hardpan Adobe ❑ 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 see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK{ Size. /a.X../.....!r.. ...... . Liquid Depth ;�.. .........�...... Capacity (.�n0 e Type Material. lix-eA No. Compartments ............... (j Distance to near .Welt �E................Foundation .... ( 0.... ...... Pro Line . 5..... LEACHING LINE [ No. of Lines -ig g i . .. Len th of each fine . .1.b.o � . ...... Total Length . .j.o�......... . D' Box ... ... Type Filter Material 5.. .. ...Depth Filter Material r - Distance to nearest: Well . SP. . .. Foundation .1,a..`.. Property Line ...`. .... SEEPAGE PIT (' Depth Diameter Numbe .....cP . .. ......... Rock Filled Yes No o Water Table Depth.............. Q........ .. ..:...........Rock Size .. J.l?_ t.3....__.... Distance to nearest: Wel! .....'.. 1 fie..�... .Foundation �.n + Prop. Lin er:..-5............... REPAIR/ADDITION(Prev. Sanitation Permit# ........ ......... .. ........ .. Date .................... ........... .) Septic Tank ISpecify Requirements) ... . .'........... :Y. ........ Disposal Field (Specify Requirements) ........ - -�'v...... O .............. -tti-•-�...:.. .. ...... .. ......... ... .. .. .... .......... ...................... ..... .. (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 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 s ct to Workman's Compensation laws of California." Signed ... ` owner P By .. .. .. Title 0 other than owner) FOR DEPARTMENT USE,ONLY APPLICATION ACCEPTED BY .. ..f ............. . DATE /.� `/.... . '..1...... .......... BUILDING PERMIT ISSUED ... ....... ............... ,r�. J DATE . .. .... ..... ....... ............ iw.......v., - ..J./�/9-r� ... ADDITIONAL COMMENTS . ....�..� ..... ......... . ........ ........ ..e . . :.......... ..... . ...... . ....... . . .. .... �'?r f/ �� .. Final Inspection by:, Date f SAN JOAQUIN LOCAL HEALTH DISTRICT ,,E. H. 9 _ 1-'68 Rev. 5M