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S. `r'OR OFFICE USE: — r__ _—- APPLICATION FOR SANITATION PERMIT - -- -------------------------------------------------- (Complete in Triplicate) Permit No. _.6J_-.-x4p_c ------------------------------------ This Permit Expires i' Year From Date Issued Date 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 -----------,__15.144------5tbSt_,b___La hr4 p-----------------------------------------CENSUS TRACT -------------- - Owner's Name -----------Marvin--------- ---------Rankin-- ---------- -------------•------------------•--------------------------------------------------Phone --Address ---------Apartznetg--- 1--Lathrop-_Apartsme _--"_"""-_.................... City, Contractor's Name __P Iglfc_-�ut de s__________ _ _ " ® p License o," / Ph a 462-82.ag-•---------- Installation will serve: Residence A artment House� Com er�al`��.�. t'aileP`trb��t�p Mote! ❑ Other "__-"""_______ _ __ _ _ _ __ - - - - - -------------- Number of living units:--"-__'I"_- Number of bedrooms ._3--------Garbage Grinder --nm----- Lot Size Water Supply: Public System and name ----Lathrop--W-ater_-cD-------------------------------------------------------------•----- ----Private ❑ Character of soil to a depth of 3 feet: Sand[] Silt eg Gay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe ❑M Fill.Material ------------ If yes, type .--_------__._---_ T� (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 within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK:[,L]_ i Liquid Depth _-_-.--_----------------- Size 1 2QQ-_50--------------- - Capacity --- �c� .__ Type -T-C04+-- Material-----�?'4 __- No. Compartments ""_"- -------------- Distance to nearest: Well ---------Ab, _ ......._.......Foundation" U____"___ prop. Line ""_._..w_____ LEACHIIVG LINE [ ] No. of Lines _"_ -- Length of each line------ �l'U a �- - - -- Total Length ------I-�----•-----•-- 1� 'D' Box ._CMLC.__ Type Filter Material -__/ Depth Filter Material -------------- ----------------- Distance ------------- -- _----...----Distance to nearest: Well ---------Vjq� ----- Foundation ------f_ra-_----_-_ Property Line ------ 1 --- -!-- ------------ SEEPAGE PIT [ ) Depth --___-----_______ Diameter Number _______ __ ____________- Rock Filled Yes ❑ No C] �,— ---------------- Water Table Depth ---------------------- ----Rock Size ----------------____-_ Distance to nearest: Well -------------------------------- -------Foundation -------------------- Prop. Line ...---------_----._ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------------•---_____I Septic Tank (Specify Requirements) i ts1 n------eV?,4._- _ ` 4►�s ey►� �1 ""-- i 5 :r " �._� S Ck al' ce.SS�� Wf 1_--=>2----r(O&4 - - 3v MC fF�2_-."�lCGla ---------------- ----- (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 Son Joaquin 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: "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 t beta _ subject to Wo n's Compensation laws of California." Signe -�--- 01 - - ---- ---------------------------------------- Owner BY ' i �----- Title -�!� ------ ----------------------- (If other than owner) - ------ ------------------------------------------- OR -------- ---------- ------------------- OR DEP A MENT USE NLY APPLICATION ACCEPTED B BUILDING PERMIT ISSUED -"" __. _ � s R------`` "t' DATE ----- . --DATE -------------------- -------- ADDITIONAL COMMENTS "_- _____ ------------- . - ------------------------------- Final -------------------------------- Inspection by: -- --------------- ----------------------- -- -------------------------- Date .tily� ----------- -------- -------------------------- JOAQUIN LOCAL�.HE TH DISTRICT E. H. 9 1-'68 Rev. 5M