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FOR OFFICE USE. �I , APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) rm e it No .........*.............tot.................... This Permit Expires f Year from DateIssaed Date Issued .-3 /�_• 77 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/#O TION ..,2.6.()4..&64 ?. CENSUS TRACT j ! a Owner's Name ...,.. .. SU.UAb.�.N ® .... . ..............................................................Phone . z .� ._.._. Address . .{ ._ n Contra me a '.fl _.�- _.......E� _' '. ►+��...... �. License �s.s. .s . ..c �j .-... Phone ... a Installation will serve: Residence jX Apartment House C] Commercial ❑Trailer Court ¢] Motel ❑Other i Number of .living units:-_...: Number of bedroomsGc7rb ge Nnder Size Q , Water Supply. Public blit System and name ' ++ ... .fl. .l.. �. �....- vi ........................ Private ❑ •°� Character of sail to a depth of 3 feet: Sand j]. Silt❑ Clay I] eat❑ti .-Sandy Loom o Clay Loam 1 � f � i Hardpan 0 Aclobe�$k, Fill Material...;. Slf.yes,type............... (Plot .pian, 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,). PACKAGE TREATMENT t ] _SEPTIC TANK; I Size....%_.......................................... Liquid Depth ............I......... . Capacity _ Material........___ No. Compartments Type . ._....__... Distance to nearest: Well ............................. ` Foundation ........ Prop. Line .-.•' I LEACHING LINE [ J No. of Lines Length of each line........_.F.. ,. ' Total Length 'D••Box ............ Type Filter Material ............._ .Depth<Filter Material . Distance to nearest: Well ----------- ............ Foundation ..................... Property Line .................. SEEPAGE PITDeptF ------------• --- Diameter ----------=--- - Number ........... ................ Rock Filled Yes [3 No 0 t f ) - Water Table Depth ...........................................---LRock Size L.,........... Distance to nearest: Well ....................:........�. ..--..Foundation -.__._....._:.:..::: Prop: Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# �y....._._�;---------•.........:.1-,�:..__ Qate --------- ----------------------- 4 Septic Tank (Specify.Requirements) _ ------ - N. en ' Disposal Field (Specify ts Re uirern ° = �_ —. ro f- : ---.__---_............. . _____________________ ----------- _ _.---___-...._-----.___+____......__.__._---_____.._______ --. $___ .. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be Clone.In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Home owner or licen- 'r sed agents signature certifies the following: 4- "I certify that in the performance of the work for which this perunit is issued, I shall not employ any person In such manner as to become sable to Workman's C pensation laws of California." Signed = -- BY ----------- = -- arm - ,LTi � `a .......... (l other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTEDTly! Y .__. .... --------------.............................. ----------• ----._...---- �:w... ,. BUILDING PERMIT ISSU -- --- ---- DATEt. ADDITIONAL COMMENTS _-.. Z. �-------- --.............� . -- ---• . ------- ....---.DATE ...............•. -----....... ----...__ - ----- ---•-•---------- :.. ..-------------------------- -------- -------- •-- -••-------- ---------------•----------------•-------------..._...._..------....._._..----.--....-----...._..._........_.._-------.....---•.--. -- -.. Final Inspection by: ---•--- - ------- ------- ..._.__..Da .... ..Date . EH 13 24 1-68 ttsv. � �.. . SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h M t