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COR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .,7 .......... _._ - --- ...... (Cantpfete in Trlpll:atel- -- _�_..-.• r=te. z ....... .f..f ...... sue Date issued L?: O-.7 This Perndt Expires y Year Erem Date Issued ........................................ t Application is hereby made to the San Joaquin Loc�l Health District for a permit to tonstnict and install the work herein described. This application is made In complionce'with County Ordinance No. 549�a d1 existing Rules and Regulations: �, .r. � ......CENSUS TRACT ..................I ,lOB ADDRESS/LOCAT N .s + . �+---q Owner's Nome .... ........ ... s. ........................................ ...Phone . T .••Gc.��- � Address - �. F..........J.�r�.ec' .a. ..........City . • � ra` ... Phone .- . g Contractor's Name e, s,.,�„', ee�es�cs�P.. ?+��*r..__.Lioense #6 -.IC 4 �1��.. ... Installation will serve, Residence Apartment Hause0 Commercial QTraller Court ❑ Motel❑Other NuMi ber of bedrooms . ...Garbage Grinder `- Lot Size -,0z...J� �••-. . Number of Living units:. ./._-- �. . .. ... i :.................................................Private . Water Supply; Public System and name ... -- E Character of soil too depth of 3 feet: Sand U Slit Q Clay ❑ Peat❑ Sandy Loam ❑ day Loam 0 Adobe Fill Material ............If yes.type...................... dMn ■ , „ . Hor wells (Piot pian, showing size of lot, location of system in relatlon to ,. buildings, etc. must be placed on reverse side.) � g NEW INSTALLATIONc (No septic tank or seepage Pit permitted if .public sewer.is/available within 200 feet,) e ! _, .n. .�, ! Liquid Depth ... - Size.. .. ....��.._� .................. _ PACKAGE TREATMENT [ SEPTIC TANK = QCompartments .,��................ ` Capacityfo� • `!��ypeF Material . . . . o. '° .... Prop. line • Distance to nearest: Well .-- .................•-••••Foundation•. . ._...__. ....� --...�-.... Length of Poch line � f• _Notal Length ��-.. No. of Lines � ••- g - "-'u"� ll: CHING LINE �j -•--• -•------.... ..... "`Depth`' Filter,Mote'lal ... ......................... . `D' Sox _ ..- Type Filter Materl61 -� ' • V 1 Distance to neurosis We / Foundbtian .. ... Pioparty line .. -- • `__...... L.. No Filled Yes � Na•❑ SEEPAGE PIT Depth Diameter •_ T - i Water Table Depth ----- 9 •--- .�::..........Rock Size .............. _ Distance to nearestr Well • i...... ..........Date . ,_ . ,_Prop. Line .... ...... .. REPAIR/ADDITION[Prov. Sanitation Permit# ........... •......... ........... .. Date . ........... ' -••---•••--• 1 { F . r . ...._...................... ...... i �Septic Tank (Specify Requirements) .........................._... ... •---•:..... ...... .--... ............. ��............. . f '.Disposal Field (Specify Requirements) ... ............. .. . .�.... ............... : .................... ........ ................. ....... ...................................i. ........................................................ c............................. . ..............................._.........._.... .. ,........... ..................................... ..................... ........ .......................... ...............�...............__... .. .-....... _ n t {Draw existing and required addition on reverse side):, .f ! hereby certify that 1 haus prepared this application anJ that the work will be donein accordance with San Joaquin C vnty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or OR f sed agents signature certifies the following: 4 4 # certify that in the performance of the work for ivihlch this permit is issued, 1 shall not'einplai► anY person In such manner as to became subject to Workman's Col pensatintti`laws of California... �r Signed Owner - s ...... ...... ...................... c/ - title •-- - ..... By (if other than owner) . OR EOARTMENY USE ONLY _ .. .......... -.....APPLICATION_ACCEFTED_TBY_.... . ... .................. DATE ... .... G'r� .,. .? _ - DATE BUILDING PERMIT ISSUED ....................... -� " VF AD1Tl AL/COMME 1 .......__ ......- ..... ... . { �..i.... .-�is�f ar......'a '`�......A .............. ............... .... . ..--............ ..... ..........-......-.. ` .�, ........... Final Inspection by ........I--......... .......pate EH 13 2h 1-68 S JOA iN I � OCAL HEALTH DISTRICT 17h 3H..