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FOR OFFICE USE: ,T :,, �: APPLICATION FOR SANITATION PERMIT _..---- 3- 067 (Complete in Triplicate) Permit No. .............. ..... This Permit Expires 1 Year From Date Issued i "*• :Date,lssued 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: : : 4 35o n/ ...CENSUS TRACT JOB ADDRESS/LOCATION . .. _. ...�5.�r�.y.. ....... . . ... ..� �a.: .� .:.._....:._..:...._...... 4 Owner's Name ..... ...... .... .. ........... .... �..' s.G` ...._.... .........Phone._ 3-7/11 Address .......... ....P 3Z •- _ ' .-!4 45- _._..._._.._.... City ,.-----..._---.____ ................ ....... # -. ._.��y. . Contractor's Name __________ _____ . ,. .. . ----- - -- R��.7..........................License Phone T...(0..............----..... Installation will serve: Residence d Apartment House❑ Commercial ❑Trailer Court 0 Motel [3 Other ... Number of living units:............ Number of bedrooms ...........Garbage Grinder __.____.__._ Lot Size ............................................ Water Supply: Public System and name ` - ' _...Private ❑ Character of soil to a depth of 3 feet. __Sand D .T_Silt f - 'Clay ❑. Peet❑ ' andy Loam g ClayLoamly Hardpan ❑ Adobe:[J :Fill Material .. ......... if yes,type .................. ... ' •. (Plot plan, showing size of lot, location ofsystem 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,) i f PACKAGE TREATMENT ( ] SEPTIC TANK f ] Size................................................ Liquid Depth ........................... 4 I 4 i Z!Capacity .................... Type ---,---------- Material...................... Na. Compartments ...:.................. Distance to nearest: Well' ....................................Foundation ...................... Prop. Line - r E "vl LEACHING LINo-No. of Lines ______________________>. L ngth of each line!....ta.._:_..�........`.._-,Tot 1 Length .... . . . ...._........ f� a �9 'D' Box .... ------ Type Filter Material ....................Depth.:Filter`Material ._.................................... , Distance to nearest: Well ........................ Foundation Property Line .................... SEEPAGE PIT [ 1 Depth .....:::............ Diameter .......:..:.:....Number............................. Rock Filled Yes ❑. No ❑V, ' Water Table Depth ....Rock Size Distance to nearest: Well ........................................Foundation .................... Prop. Line ,............ REPAIR/ADDITION(Prev. Sanitation Permit# ...................:.............. .::..... .._._. ............ 1#r Septic Tank (Specify Requirements) ...........::...-.:... ......N A_-_____.._._.._.... . , aX-.5.._._. ............. . . ------ Disposal Field (Specify Re uireens' _ _.� r (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 withfSan Joaquin 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." • 1 Signed .. Owner • i ` .. Title By _........ ... .. ....... __.. --.... (if er than owner) x FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...../527 ..........................................-......_:.............. DATE ....�/ .97:72.3f............... BUILDING PERMIT ISSUED ............. ... ...:............DATE ...........:..................:............ ADDITIONALCOMMENTS ..................................................................__,....................................... ..._... =_..:. .. _ --- .. ..........•..................... .• ....... .._...._.....----- ....................._ ----•------•---••------ - ------------------ ._.... ................... ........................... .................................... Final Inspection by; .... .... .. .rte .................................. ................................................Date rl"1 � SAN JOAQUIN LOCAL' HEALTH DISTRICT E. H.13 24 1.'68 Rev, 5M 7/72 3-M