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FOR OFFICE USE: APPUCAMN FOR SANITATION PERMIT ............."F. .t_ ................. (Complete in TrlpNcate) Permit No. ..76`.�°7 Date Issued ....................- This Permie Expt[es t Year from Dole loved 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 existine Rules and Regulations: JOB ADDRESSAOCATION .../. Ve4= TRACT ............. Owner's Name ��1,'�. ,.ff/hi ...... 1 .L1. .............. Phone ." Q -- Address - .(. '.D .... .. �✓ ._._ !? _. "`�...*Cityll� ......._ Contractor's Name -------•- .......... _.License ..... Phone Installation will serve: Residence j$Apartment House{] Commercial OTroller Court 0 Motel❑Other............................................ Number of living units:..- . --- Number o€ bedrooms .._ Grinder - .. :Garbage Gri ..-•---..... Lot Size .�G.'r.��.�.. .......... Water Supply?Abjblic System and name ................................. Character of soil to a th of 3 feet, Sande Silt Clay . peau .. .w......... .. ........ ........Private ❑ ❑ ❑ Sandy Loom❑ Clay Loam❑ Hardpan Q Adobe❑ Fill 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 within 200 feet) v PACKAGE TREATMENT [ J SEPTIC TANK f ] Size. ._..__ ................................................ Liquid Depth ................... ..� Capacity .................... Type ----------- --- inl.............. ... No. Compartments ...................... Distance to nearest: Well ........................... ......Foundati Line LEACHING LINE l I No. of Lines ........................ Length of ....... .............. . Prop. ---................... line-. Total length ............................ 'D' Box ............ Type Filter Material ..... .............Dep Filter Material Distance to nearest: Well .................... .. Foundation ........................ Property Line ....... SEEPAGE PIT [ ! Depth Diameter ....... Number ...... Rock Filled Yes ❑ No ❑ Water Table Depth ...................... ........................ Size Distance to nearest: Well ............ ....................... -Foundation . Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit#t Date Septic Tank (Specify Requirements) ..................... .. Disposal Field Specify Requirements) ... . ._�.----, ---. ... - . ..._............... .. . _.. . ---.. ..... -----•_ (Draw existing and required uired addition on reverse side) I hereby certify that I have prepared this application and that the work will be done M accordance with Son County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Nealtiv DisMc#. Nonce owner 4lkm* 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 ..-G.....4P.................................. Jule --------- -- -----•-----....----•... ............................. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .... �,-,_-• - _ t. ........ . ....................... ---•-- -----.. DATE -�.6�,7/..............: BUILDING PERMIT ISSUED ......... ............................ DATE .... ADDITIONAL COMMENTS ................... •. --•........ ..... ---- --- . . -• ---- --•-. ..... ...._ -.... --------- ----------------"----------- -- ---...................----..........--•---�-�---- Final Inspection by: .-.-- .- ;:.. . ..............Date -. ""' EH 13 2h 1--613 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m