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k FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 74/ (.. Permit No. ..................... / (Complete in Triplicate) .... ....... This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCAT N -�._...../a. 7.. �/.e f..�`rCENSUS TRACT .......................... Owner's Nome ...... . . ..... .... .-- ----•-..... ......... one . ... Address " ... .. h......... City ....--- Contractor's Name . C!cg r eL. ..li,r4a _.License # /111 ' Phone Installation will serve: Residence%Apartment House,❑ Commercial ❑Trailer Court 0 Motel ❑Other _ . .__ -1---........ ....... lV � , Number of living units:_ _ Number of droa s --K.....Garba a Grinder ! � /057'lot Size � _/t .l-l.V...... . Water Supply: Public System and name �.. �� - ❑ ...._...... Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat F] Sandy loam Clay loam ❑ Hardpan E] Ado 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 pitpermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT W SEPTIC TANK 1r'et6' 1C Size ' Liquid Depth ..47 .... ..., Capacity//�6 Type� Mat rI. i��-.- No. Compartments �� r el Distance to nearest: Well . . �� ......._:...Foundation .. .. ... Prop. Line ��._.•_.._..... LEACHING LINE No. of Lines cZ Length of each line �- 9OTotol length / ............. 'D' Box Type Filter Material _ -._...._Depth Filter Material p.`........................_.... c� �Distance to nearest: Well _ _...:�-._... Foundation 1!. _...-_..._._.. Property Line ................ SEEPAGE PIT [ ] Depth _ _ Diameter .._.._..-....... Number Rock Filled Yes ❑ No 0 WaterTable Depth ... _.:_ ... .................................Rock Size ..... -------.._.-_.-.-_---____ Distance to nearest: Well .....................Foundation .......... . . Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ........ _. . .... ...... .._.__..... Date ....-----._.......................) Septic Tank (Specify Requirements) -- ._..._... - ........... - ..... ..... .:.................. ........ -••--- Disposal Field (Specify Requirements) ...........------- ----------- --------------- .. ___ .-_ _ _ _. _...._...._... _-........ _. ----- -- ........... ........ - .._ _........... .. (Draw existing and required addition on reverse side) c� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqui 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, I shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .... --- :_. .--- Owner — BY . � /:ems.. v / Title � � (If other than owner - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDBY _.. DATE ?--S/?IK ... ... BUILDING PERMIT ISSUED . __. . _. ATE ADDITI NAt, COMMENTS �tvs�C�lctl. . _.. .�?on �-i w:.aj..s- 4A.11y_. fn .,.�a24..-Y.s , e 'E-yd/r, - fra ,• e... �1• Wl 6r. . -- ,W Final Inspection by. .-- .. .- _ _.. .._ Date ... 7� ..............•_ UIN LOCAL Q HEALTH DISTRICT SAN JOA L ( ' E. H.13 24Rev. 7 72 3 i