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.FOR OFFICE USE: APPLICATIO14 FOR...SANITATION PERMIT .. _....................�1:.?<. }3.1._�7 Z (Complete in Triplicate) Permit No. .... �( ... Date Issued .... ..�.1..�:3 ........................ . E .............. This Permit Expires 1 Year From 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 compliances with County /Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N ,..........7...D..__.5.,�1.-....N...c....�A��ff .T� IC-.G...................CENSUS TRACT .......................... Owner's Name r � ..Phone Address ................ ............. L ....................................................... City ................................................... Contractor's Name ....... I... L.,E-/�....................................License #, Jr Phone Installation will serve: Residence Ill Apartment House 0 Commercial❑Trailer Court Q Motel ❑Other ............................................ Number of living units:......I.... Number of bedrooms -......Garbage Grinder ............ Lot Size .....614C—A 555............ Water Supply: Public System and name .."</.wp ..........................Private ❑ Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type............................. °(1 (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,) f PACKAGE TREATMENT [ ) SEPTIC TANK j Size.-,.I;..X0.L X.'J ........... Liquid Depth _.P,4 ...... ....-•-- Capacity ..,; P _..__ Type /......A*V Material...................... No. Compartments ,...l..._..... i Distance to nearest: Well .....'.... ....................Foundation ../10............. Prop. line.... �........... LEACHING LINE [ j No. of Lines ....�.............. Length of each line e......,�� ............. Total length``7.U............... 'D' Box .../ / .... Type Filter Material 1...�`..,�c��.Depth Filter Material ..._f,�:................................ Distance to nearest: Well........................ Foundation ..... Property Line SEEPAGE 444— [ j Depth 4Kt/- o-.- Diameter ................ Number ..........2�......7.. Rock Filled Yes No Q Water Table Depth .............7.�.. .. Distance to nearest: Well ............. `d.....................Foundation, ....._�.4...�... Prop. Line ..... ....... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) SepticTank (Specify Requirements) .....................................................................................----•-..............._............._.....••-•._...... DisposalField (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. 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, 1 shall sot employ any person in such manner as to become subje t to Work 0Compensation laws of California." �.,. Signed ---- .....I. ................................................................ Owner By ................................••••-•.................-•-................... •............. Title (If other than owner) PARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ...... .. ..................• ...................................... DATE -� 1!.. ..: ............. BUILDING PERMIT ISSUED ...... .... ...... . . .. . DATE ........................................... ADDITIONAL COMMENTS ..... .... ...... .. ... . ...---•-••---•---......---•................I. ... --•- •......... ...••••-••---.........--••-•••---............................••---•...........................................- -•--- ....................................... . . . .. ...................................................................................................................... ........ ...................................... .. ....... . . .......................•--................................... ..... Final Inspection by: ....... ..........•Date .....P..-..I..... .. . - ........ JOAQUIN LOCAL HEALTH DISTRICT E.H.J-3 24 .'68 Rev. 5M / /1'1 2?�� ! G� 1 72 3