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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT .__.....-•..... ...................................... � � Permit No. 7S-� ICornpleto to Triplicate) •............. d IG Date ssue ` ... This Permit Expires 1 Year From Dai issued `2- -74__...... 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 .-./ .4-../-...-A=................. / ........-•-- •.............................CENSUS TRACT �) i............ Owner's Name A f,, ;CL............................. ....: Dne Address --- �j l ._ . ..-. _ .._.... _ ....City1 ........ Contractor's Name 11 - .......License .-- Phone Installation will serve: esidence Q Apartment House Commercial QTrailer Court Q MotelQ Other................................... Number of living units:.-........ Number of bedrooms .1-------Garbage, Grinder .... Lot Size _&.-6.... f..... �... ......... Water Supply: Public System and name Private Character of soil to a depth of 3 feet: Sand QClay Q Peat Q Sandy Loam 0. Clay loam Q Hardpan 0 Adobe U)-IF-ill 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available withln 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size---------------------------------.............._ Liquid Depth ...................... Capacity ---- Material...................... No. Compartments � � 00 Distance.to nearest. Well ....................................Foundation ................ Prop.Prop. Line ....................... C_ LEACHING LINE [ } No. of Lines .............. ......... Length of each line................... Total Length ....... j 'D' Box ............ Type Filter Material ..Depth Filter Material - Distance to nearest: Well ........................ Foundation .........-._........_... Property Line ................ SEEPAGE PIT [ ) Depth -------------------- Diameter ----________-- Number -------- ................... Rock Filled Yes ❑ No C] Water Table Depth ................................................Rock Size ..........: - l Distance to nearest: Well .,_.......... ---------------------------Foundation .................. Prop. Line ...................... ; REPAIR/ADDITION(Prev. Sanitation Permit# .... : ,-- pate ---•---- ....................... Septic Tank (Specify Requirementsl ........C tzd,xr.......... :.: . 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 Joaquln 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 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 BY C - Title �- -----....._•--•- .. . (if o er than oerj :..._... FOR DEPART UiE ipNLY APPLICATION ACCEPTED BY---------•-------------- DATE.._:-�a=d` 3r? ----------------- -------- ' -------------- BUILDING PERMIT ISSUED _..----•--•--••--- DATE ADDITIONAL COMMENTS .......................... -------- ----------------- 9? ------••-•----------------------------- •- ----•- ----------------- ---------- ---------------- __ S_.------ EH 13 24 1-68 Rev. 5i SAN JOAQUIN LOCAL HEAL DISTRICT 8/74 3M