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FOR OFFICE USE: E APPLICATION FOR SANITATION PERMIT ----------------------------- �7g- 7S- 7 {Complete in Triplicate) Permit No. . ...........•- --- •..............:.................................I........ ., This Permit Expires 1 Year from Date Issued pate Issued .. ?.`............ 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. 549 and existing Rules and Regulations— JOB ADDRESS/LOCATION �...............-. /..G... .... .... ................. ........CENSUS TRACT Owner's Name .. . . _. ............................................ ................Phone _................................. Address ...--- �_ .. ------------R----------------- ... city .._.•..G ............................................... Contractor's Name ----.-_---- V- - .Ai..-Vea .... —11cense # _! Phone ........................... ...... Installation will serve: Residence❑Apartment House] Commercial❑Troller Court 0 Motel ❑Other ..... ...................... Number of living units:.-7!_------Number of bedrooms ............Garbage Grinder ............ Lot Size .... 141P14—. Water Supply: Public System and name .........Private [!}- Character of soil too depth of 3 feet: Sand'❑ Slit❑ Gay ❑ Peat❑ Sandy Loam ❑. Clay Loam ❑ Hardpan l3 Adobe 0 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.l NEW INSTALLATION-. (No septic tank or se go pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( SEPTIC TANK-176 Size., _ -•_ _ A_.._ar Liquid-`Depth ... ....... Capacity ---5-9-0—PL-1-Type io.. . Material. No. Compartments ,2...............J 11 Distance to nearest: Well .............Foundation P. .... Prop. Line ......if LEACHING LINE {� No, of Lines -------)............... Length of each line.........+00.kr ... Total Length .....YC V Bax ............ Type Filter Material ......Depth .Filter Material ....I-19............................:.....Z Distance to nearest: We l# ......�+D.�rl'..... Foundation Property Line .... SEEPAGE PIT (� Y Depth .....cid-47f - Diameter ..:31..90....... Number .........../............... Rock Filled Yes QT"'No . LS � . t rf It Water Table Depth .............To.. .. .......................Rock Size ... .. ........ �+ Distance to nearest: Well ......... ta0._ .............Foundation ------/.,0./-/—Prop. Line ..... ...� REPAIR,/ADDITION(Prev. Sanitation Permit#..--..-- ............................... Date ........... -..................... 1 SepticTank (Specify Requirements) -----------------------------------------------••------ ---•-----•----..........----•............................---•••--......_.......... Disposal Field (Specify Requirements) ------------------------ ------- ----- --------------------•- --.-_---------------------------- --------•-----•--•--------- ...................... (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 F 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: "1 certify that in the performance of the work for which this :permit Is issued,.) shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - --------------------------------------- Owner By ---- -- -------- ------------------------ -• ----- --- f��.... � "? ----- Title --- ........................ Ilf other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- •-------------------- DATE `.... BUILDING PERMIT ISSUED ----------------------- -------- - ---- -_ ....................DATE _--... ( ADDITIONAL COMMENTS --------------------------------- ---•..._..... .................... -----............................ .-.:.............---------- -------------------------------- -----------------------------------. -------------.------1--1...... . ......... ... .... .. •------- ----- ........ ------- ----------•----••-•-------••---•------------•---------••-•-------- .............. •-r-• ^, Final Inspection by: ------------- ----•----------- ...........-....................... ............. Date ....-... ?EH 13 13 24 1-68 fbew• 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M i ..