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POP, OFFICE USE: APPLICATION FOR SANITATION 'PERMIT r Permit No. .-7S`-- p �(/J {Complete In Triplicate} < Date'Issued /. -/7_•- S` .............................................. This Permit Expires 1 Year From Datelssued Application is hereby made to the San Joaquin Local Health District for a;�permit to construct and Install the work herein described. This ap�li�c, tiaoq is made in compliance with County Ordinance No:,549 and existing Rules and Reguhbtions: j JOB ADDRESS/LOCATIO - � ..................CENSUS TRACT .., f Owner's Name ...-----•-- -------- -- -----.._. ••`. ..._.,. ..r...........:....:................ hone s. -... ............ �}— �c.c/ P Address .._..... i�:r�Jt -� .................• City .... Contractor's Name ' -� ------.License # �..� 7... Phone --- installation will serve: Residence Apartment House _.--Commercial❑Trailer Court 0 p Motel Q Other I Number of living units:..../--.. Number of bedrooms ....,�,,1-.._.Garbage Grinder .........._..tot Size . _lp bra..-.-- .•-••• Water Supply: Public System and name --------------------------------------------------------.................... -...............................Private ' Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam.fl Clay Loam ❑ Hardpan Adobef Fill Material ............ If yes,type............... ............ (Plot pian, 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 seepage pit permitted if public sewer is available within 200 feet,) uu f r PACKAGE TREATMENT [ SEPTIC TANK Size...... •/ ....................... Liquid Depth ... ......... Capacity � W- ......_ Type . - - "Mater€al_. lo: Compartments ..:. ....... -••- d {._.�... t Foundation _. d`�........1 Prop. Line __s Il .......,0 1 Distance.to nearest: Well _._......s1. LEACHING LINE j�] No. of Lines ....... ....... i r � r , `� _.._..... Length of each line..-----�'.�.•------._... Total Length .-./..7-..0................. Type r -- lt Material --- 1 '. .............................1 o f D' Bax ..__..`�T e Filter Material ....Qe Depth falter -- - s 1 m at.ion s T....�d; .. `. .... Property Line .. pro SEEP�,AGEMPIT Distance t��arest: Dameter Abe_._....._.- Rockf Filled Yes No Rr�Water Table Depth ------------------------- ---- .............Rock Size - =--�.Di�ance-ta,neorest:,Well f --!- -----._Foundation lJ0-..-f`_. Prop Line .. r � REPAIR/ADDITION(Prev. Sanitation Permit# --.---" `- --------------•---•----, Date=--=-- .................... SeOtic_Tank (Specify-Requirements): - -------------------------------------------------- ............................................................................ Disposal Field (Specify Requirements) ---------------•-__.---------------------------------------------------------------------....................................... .---- -------------- -------------------------------------- ------------------------------------------------.------------------------------•---------------------------- ...................... ----------•------------ .............I........ _.._..,�+ 3 (Draw existing and required addition on reverse side) 7R I :hereby certify that 1 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 Son Joaquin Local Heal&Dlstrict. Home owner or Iicon- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------_ ................... ........ Owner ' B Title ..-....... �- [' .__..._----- ------------ ....... Y (if other t owner) FOR DEPA MENT PSE ONLY 1 APPLICATION ACCEPTE BY _--.--' -_-= ------ - - --------. DATE _ ....��:�_.. J._. I - , BUILDING PERMIT ISSUED ....................... - ---- -----•-•------------ ....................................DATE _ •------- --- ADDITIONALCOMMENTS ............. ...................---...--•--------. _.__._._.._._..-......._......------.._..-- ----.... -_--------=.................. -------- -----------------------•----....----.--•---•------• - --------------------- ---------------------....._....... .......--- ••--.--•-------....._ -- --- ---- ... Final inspection by. _. ._-__-- -- Date .....i . --------------- ER J.3 2h 1-68 �V- 5H SAN JOAO N LOCAL HEALTH DISTRICT 8�7� 3M