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FOR OFFICE USE: I a r_ot) APPLICATION IF♦'OR SANITATION PERMIT 761 / (Complete In Triplicate) Permit No. ..................... �i---7,G This Permit Expires t Year From Date ksuad Date Issued .'1'1--77Z. 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/LOCATIO . . Q --- - • ' �"-. -' .....•CENSUS TRACT .......................... Owner's Name .._._. - '--------••.......................................... .. ..Phone ..........._..................... ..... Address . . . ..�( �. ... cr . ty . .. Contractor's Name --------- -------__ ............... t ...... . Ci ,•,_; --- �/ :1..._-..license# „1S�P Y_ Phone .••........................... Installation will serve: Residence fgArt ent House Commercial[]Trailer Court jMotel❑Other............................................ Number of living units:-..--- ___ Number of bedrooms ....-.Garbage Grinder ._.._._..._ Lot Size ...................................... ---....--••-•............... Water Supply. Public System and name PP ri ..................................... ......�_..._........... ._......_______....._........._Private Character of soil to a depth of 3 feet: Sand b Silt 0 Clay Peat(] Sandy Loam 0 Clay Loam Hardpan 0 Adobe [J Fill Material ............ If yes,typo............... ............ ; (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 see age pit permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TAMC i< Size. �_Xl.Il.'..y_-. • -• --•••---•-• Liquid Depth ...J .................... Capacity _1 tnD_.-•--- Type Materia(._4"c.�. .`p:��---- No. Compartments �,.............. 00 Distance to nearest: Well __________-4` Foundation ....... Prop. Line ....ter W LEACHING LINE No. of Lines ------- .......... Length of each line....._4P' .e Total Length 'D' Box ...../_..... Type Filter Material .._...vS..t....Depth Filter Material .../.!�_.'� .............................. i Distance to nearest: Well _......1_Q._ ......... Foundation ._.I_G_%.{_...-_. Property Line ...... ...... SEEPAGE PIT (e Depth --_-'Z Diameter -_. _ .: _. Number ..........3............... Rock Filled Yes [3"0"No 0 . Water Table Depth ............ G?Q.._lei--- ...........Rock Size --�/.�-x--•..' ----._•_ Distance to nearest: Well .........1a&:. ...........Foundation --- Prop. Line ..... .. REPAIR/ADDITION(Prey. Sanitation Permit# ..........................................•• Date .................................. Septic Tank (Specify Requirements) __..•__.._•....................................................................... . o 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 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 shalt not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ------------- ---- Owner ,r BY ---- ........... title (If other than owner) F R D ARTMENT USE ONLY DATE . �// APPLICATION ACCEPTED BY _-: .o..._._ BUILDING PERMIT ISSUED ------.._......._._................. DATE ----._. ...-----------------., ADDITIONAL COMMENTS ...... ------------------- - � ------ ---- ---- Final Inspection by: ..'..r. . Date -- 13 2L 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M