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i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT" (Complete in triplicate) permit No. .. y........... . ................I...__ - 4_ ........I...,._......... . This Permit-Expires >I.,Year From^Da to Issued. 4 } Date issued . -!a �-•.7.� i•i..rrrribYr� S Ytl �� •t. - t Mme. l•-'. � til 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 Ordinance No. 544 and existing Rules and Regulations: l 108 ADDRESS/LOCATION �b3� �►/ 'fjryj• �- _ .._..._..• CENSUS TRACT ......... Owner's Name .. ...._.... ._ .. . ' ..... 121. 7 � R .- � .. %-.Phone - Address ._.._._7.` �Q..... , �°r: .............. ...................... city . .�' ��{!_ • ------••••... Contractor's Name .. . `� -� — .•.••..• f�`�le ... ....................License #�P/;e`a_s Phone . Installation will serve: Residence X Apartment House C] Commercial°OTrailer Court . Nfotel (]Other .............. f Water Supply. Public System Number of livingunits:" ber,of, bedrooms _..Z...Gorba a Grinder __._ : Nutri . 9 .._ Lot Size �Pl�_.X--,1� - Character of soil to a depth of 3,feet: y and name ................... ... -•-•-Privote>] P San ❑ Silt❑ Clay ❑ Peat[] Sandy Loam fl Clay Loam Hardpan,[} Adobe F] Fill Material ............ If yes, type ....... ..................... plan, showing size of lot; Iota-tion_of. system in relation-�,towwells,-,.buildings,.._etc.__must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SbTIC TANK-f '� Size.............................. ILiquid Depth Capacity .......................... � .' _ Material-------. .. No. .._.........:'...._. Type Compartments { Distance to nearest: Well •--Foundation ....._ r ----_....-•----- Pop. Line ......................6 LEACHING LINE: [ 3 No. of Lines .`:................n'.L"en th of each line-----•------------- Total Length 'D' gox' Type-Filter Material ---------Depth Filter Material .- ii .. ................ Distance to nearest: Well: . ....:............. Foundation _... ...---•--...... Property Line ....... PIT.- Depth Dia ---•-•---. Number ..'. .`� Vp1 _-.----- ------ -----=- Rock Filled Yes No C Water tab rable Depthf ...................Rock. ........... Qistanc ? e to nearest: Well. Foundation _.... Prop. Line ...--••----•-• r REPAIR/ADDITION(Prev. Sanitation Permit#� ................ ' Date Septic Tank (Specify Requirements) ------- Disposal Disposal Field (Specify Requirements} ' �rG �. �-rtes 3 . . f r..... .. ZZ ' ---•----- ....................................------------.............................................................. ...................... ----------------------- (Draw existing and required addition.on reverse-side) I hereby certify that I have prepared this application anda fhat, 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. Horne owner or licen- sed agents signature certifies the following: i --- "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 subject to Workman's Compensation laws of California." Signed .............. . ................................•----.... _ Owner 4"... By ............ ........ ... - .......................... Title .. of er than owner} F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-_'. ... .. ...................... DATE _.�'._Z............ .•--• BUILDING PERMIT ISSUED ........ ----•-. ---------------•--_ ......... .................................DATE ADDITIONAL COMMENTS .......................................•-•-••------•._...-- ...........•............................................ ----------------- - .......................................................... ••----•-•-•..•........................•-•-----.......... ---------------------------------------Final Inspection by.. ...............-.............................,Dato ..._._,..--•--•......................... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.].3 24 _ 1-'68 Rev. SM