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FOR OFFICE USE: APPLICATIbN FOR SANITATION PERMIT _........ . ...... Permit No. .72 (Complete in Triplicate) """ ".! �. ......... This Permit Expires 1 Year From Dote Issued Date Issued 4_7/.. 73 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ..Sia ��..'F_ . ... Cc< � -' _ ......... . ._..CENSUS TRACT .......................... Owner's Name ..... .................................. ...... ..... ......Phone Address /a -:�f .'. .. .� .. tet- .{ ..... ...... City ------•--_--- ......................... Contractor's Name . y .� �ri _ r � t.....License # `/y�.�`�` Phone Installation will serve: ResidencePkApartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other _. --- --- Number of living units: Number of b rooms ....tet ._..Garbage Grinder '�' lot Size ....��`. 1611...�� f s Water Supply: Public System and name ..--- ...lt4hrG�� /. ........................._._-_........ ..........Private Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam 0 Hardpan ❑ 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.) tN NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK}'' Size..laf �ie4.�._��'.-�". __ . Liquid Depth ....��_........-. Capacity/.I Type -'� �` Moterial_01-u-c'A I+4o. Compartments -. - �] . l Distance to nearest: Well . ... .. ..............Foundation ./ Prop. line ...d --............ LEACHING LINE J( No. of Lines rZ Length of each line Total Length 'D' Box Type Filter Material tf� ......Depth Filter Material ...!>'� �... ...... f f Distance to nearest: Well ?. ._.._..._.... Foundation .- Property line .......... SEEPAGE PIT I 1 Depth c2S— r__.. Diameter X72..`....... Number _. __._.-...... Rock Filled Yes Qr No [ Water Table Depth _.-- c .............................Rock Size _... ....... Distance to nearest: Well -.ILtC._..._.....................Foundation ....fel Prop. Line : .............. REPAIR/ADDITION(Prev. Sanitation Permit# ........ _ ...... .._................. Date ....:.__........................) Septic Tank (Specify Requirements) .__ __. - .. . ---------.._.._.... .... ...... ............. .......... .. ...... Disposal Field (Specify Requirements) ----- - __ _.. ........._.__ _ .............. -- -- - ...... -- ........ ...... (Draw existing and requiredaddition 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. Hem* owner or lic*n- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California:' Signed . Owner BY �s',�- v - Title _ ..- (If other than owner) FOR DEPARTMENT USE ONLYl��T _-__• _-��__ .._.�__. _ APPLICATION ACCEPTED BY C' _ DATE -4 BUILDING PERMIT ISSUED r __ _ _-DATE . : . . ............ ADDITIONAL COMMENTS .--- _ ...__. _ . .... ... ............ . ... r Final Inspection by: Date .. SAN JOAQUIN LOCAL HEALTH DISTRICT $ E. H.1.3241-'68 Rev.`5M 7/723 ,4