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FOR OFFICE USE: APPLICATION FOR SANITATION ,PERMIT .............................�...__......_ ICamplete in Triplicate), -1; Permit No. I[ •-••----••-- s "' " This Permit Expires I Year From Date Issued Date Issued pp gg ..Q.-.!._...r�..:.-„ Application is herebylmade to the San Joaquin Local Health District for a pernit to construct and instalI the•'work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA710N - h Owner's Name '. . CENSUS TRACT ....::.:..::.` Address ?,�� ..----•-. -- --.. ..........................Phone 1W 47ZI Contractor - - Cl .......................... Contractor's Name .�/4`. 5.`,�, �C' f ,. / .._ E '--:........License Installation wil( serve: # 7,-4C --• Phone. Residence C?Apartment House Commercial []Trailer Court 0 Motel-]Other _..___.:_._.-: Number of livingunits ..__ Number of,bedrooms a .... Garbage--G--r--in--d-•e•-r•-- Y .. Lot SizeWater SuppIy. Pulic S st and name ... ...�.J..�..'......,.. , Character of soil to a d pth•of a fi et: Sand j]] Silt Clay " "" "' Prrva to ❑ y [] Peat[� Sandy. Loam 'O . Clay Loam 0 ' Hardpan[] Adobe Fill Material ...... If yes, (Plot plata, showing.,.size�of,lot, location of. system in relation- to wells, buildings, etc. must be plated on reverse NEW-INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 20Q feet side,} PACKAGE'TREATMENT .} [ J , SEPTIC TANK i ] Size............... ---------•-•.............. Capacity T e ..... •--._...__f._... yp Material. .. Liquid Depth - No. Comp _ Lance to nearest: Well' n ...... artme is � N'S .................•----. •... �.)� o. Foundation .._........:.:........ Prop. Line LEACHING LINE .._... .................- ' of Lines ---••---•--••----------- length each line--.--•------ Tota! LengtFi ........Type Filter Material .............. �Ip __.•..Depth Filter Material ... -'-Distance to nAIIearest. Well .._. ............... . :. Foundation :-----_•-- Property Line SEEPAGE PIT � -----..._'. --•-_-•• ' E ) [Depth Diameter ...... Number -----�-- _.... Rock-Filled - .�. _ -----••-•- Yes pp ---- ' 1Nater Tdble Depth Rock Size Distance to nearest: Wel! __....----• --....._.Foundation �h Pro - -•-•--•---••- Line . REPAIR/ADDITION(Prev. Sanitation Permit 96� p- ................... . Date Septic TankS I pecify Requirements) _................... '......_ Disposal Field (Specify Requirements 1 .......... ... ::: e::----- =_62 e_SS!.l..._....._ �' ` -------------••---- -•------ ........................... ........ = ....... �, --•-------------: ..:.. �-_......._...._.._... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Statei[Laws, and Rules and'Regulations of the San Joaquin Local health District.Home owner or t cen. I sed agents: signature certifies the following "I certify that in the perfamance of the work for which this permit is issued I shall not em to an � � as to become subject to Workman's Compensation laws of California." p y y person in such manner' Signed ........................... J _ u---- •••----- ............. Owner a By II' ...........h -- = .._..'°Title __. (If other t own OR DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY .. BUILDING PERMIT ISSUEDf li ---...... ......... 99 --..........I.................... DATE {......- ADDITIONAL COMMENTS I: ......:...-DATE ................................................... ....................._. r ��'... ................•---•. . W. ---......... = .............................. :--- ••- Final Inspection by_..- .. ...... :._..:. - ` 5 -. --.--- ------------- JO - .... _ .—' .SAN . AQUlN LOCAL HEALTH DISTRICT E. H.13 24 1.'68 Rev. 5M _ e t