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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :...:.... .......................................... -741- 9P?7 (Complete In Triplicate) Permit No. ._................... 1 .... / .. This Permit Expires if Year From Date Issued Date issued . ..._ ...7... 2A.I1 Application is hereby made to the Son 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/LOCATION .......... ......._ . .........CENSUS TRACT ..................... Owner's Nome ...... /I------ ....s~�,7 �'1 L - - - - -- "-_--•............ . ...............Phone .........................._-.....--- Address ....__... - - - -..--- --- • ---- :. City ..., . . ......................................:• . . i Contractor's Name ----irk--��-•.,� �- ----..J..`t,'�.C.?�d..S�'+:�'----.License # I �5!P. Phone ..� . r Installation will serve: Residence VApartment House Commercial OTrailer Court 0 Motel ❑Other Number of living units-------- Number of bedrooms _._,....Garbage Grinder -.y`VIR,S Lot Size ............................................ Water Supply: Public System and name ................................................................................................•_...........Private Character of soil to a depth of 3 feet: Sand 0 Silt.0 Clay 0 Peat❑ Sandy Loam 0 Clay Loam D �. Hardpan❑ ,Adobe 0 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 ori seepage pit permitted If public sewer Is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size................................................ Liquid Depth ...................... Capacity __ rpt .. Type /I t�7Materialt-�Rt4,1.49.da No. Compartments .. ,... i Distance to nearest: Well ---/-0. ?1....... .........Foundation ..... Prop. Line ...OW........... LEACHING LINE { ] No. of Lines ..___. ._ ___.._ Length ofr each line...._? ......... Total Length ...�.2�--�............. ' 'D' Box .../...... Type Filter Material -.L� ::.......Depth .Filter Material ...../_..r...-.....I..................... Distance to nearest: Well ....t-0.5 ...... Foundation .......... Prop" Line _. SEEPAGE PITr ` [ l Depth ._ . _,,�___.._.._. Diameter ---3. Number .....�. .. ..... .......... Rock Filled Yes ' No >D Water Table Depth ............. ..................................Rock Size ....J-1.,..................... I Distance to nearest: Well -____-__.•_-......Foundation ..��..._. Prop. Line ... ........ REPAIR/ADDITION(Prev. Sanitation Permit;# ............................................ Date ................. ................ SepticTank (Specify Requirements(. ......... --------- ....................................-..............-....................................._.............................. 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. 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 not employ any person in such manner as to become subject to Workman's Compensation laws.of California." Signed ........ ----•-----------------------•• ----------------•----••-• -------------------... Owner (If other than owner) -------------------- Title c FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... - k •-------- --------------- DATE .__�A . � -------- ' BUILDINGPERMIT ISSUED ------------------- ------------..............................--- ..-----------.DATE ....--- ........._........--••-------•• •. ADDITIONAL COMMENTS ---------- --••--------------- --------- - ... ------------------------- ----------------------•------------------------------------------- ................................................I....................... ----------------------------------------•--- /� Final Inspection by: ... ------•------........................................................Date .....�v ..?.�............. EH 13 24 1-•68 itev. 5'M �� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M i F s