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FOR OFFICE USE, APPLICATIQN- FOR SANITATION PERMIT }.................. / . { ,. a',. �. i Permit No. ..73.`.�4.35 {Complete In Trip ....... ..... ........ ;1o1 This Permit Expire%A-Year From Date Issued Date Issued . � ./.�2. Application is hereby made to the San Joaquiri,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 Name ... .� ...�`--.......................... .... Phone .. ... ..... ................ Address ty ...............I ................. ..... .. Contractor's Name _. ��_.. �— ...............................License #077-..1qX"P.'.... Phone ...:-`Z. ' Installation will serve: ResidenceXApartment House J-] Commercial ❑Trailer Court 0 i Motel ❑Other ............................................. ,. Number of living units:.../----- Number of bedrooms ...._.Garbage Grinder ?_ _. Lot Size . ........... Water Supply: Public System and name ____ dd!/ -_ _..._...:... Private ❑ Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ Peat❑ Sandy Loom CI Cloy Loam Hardpan ❑ Adobe Fill Mdterial ............ If yes,type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse,tilde.) NEW INSTALLATION: (No-septic tank or-seepage pit perm itted_ifwpublic_sewer-.is-oval lable within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size ..............................................- Liquid Depth _.....__._._:_.. ..._... -� Capacity . Type .................... Material----------------_F------ No. Compartments ........___._......- 1. Distance to nearest: Well .-----• ___________________________Foundation ..._._......._.__.',..Prop., Line ...................... LEACHINGLINE - No. of lines { l j� _..._ LINEA-] _.._... Length of each line............... ......... Total Length .._ _ 'D' Box ....._...... Type Filter Material .....:..............Depth Filter Material `' f Distance to nearest: Well ........................ Foundation _..._...------.....__... Property Line ------....•.............. E SEEPAGE PIT, 1--} /Depth ----- ----------- Diameter Number -----------------------._-_. Rock Filled YYes ❑. ` No �{ f. Water Table Depth .Rock Size ( � `Distance to nearest: Well .._.. ---------------------------•---•---,....Foundation ...........--••---.. Prop. Line --•--•--...--- s - RkPAIR/ADDITION(P.ev. Sanitation Permit�# _.. /:_.l':U�-��.:...:::.T-:: Date- ) Septic Tank (Specify Requirements{ --••• -- _.... ----•--......................_.. -----•---....... Dis oral Fie[ (Specify Requirements) y t /A .. _. 'L� �-°'------- ,�� "' ... . ............ y' C n . . j•,, {Draw existing and required addition,on reverse side) I hereby certify that-I have prepared this,applicationand that the work will'lie done in accordance.with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local`Nealth District. Home owner or licen- sed agents signature certifies`the following: "I certify that in the performance of the work far 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 .. _.......-•----. hf , . Owner ��:_------BY ....:..` ...---.... title er than40ner) w FOR DEPARTMENT USE ONLY >Q APPLICATION ACCEPTED 8 ............................... DATE .. .4...A.._...' ... BUILDINGPERMIT ISSUED . ........--....................... :. = - --------------------------------------------....DATE ........................................... ADDITIONAL COMMENTS ....................................................... -----------------•------------- _...................................... .....-• - _... -----------------------•-•-•- -• .-- •-•--.I............................. .......I...•••..... ----• ---•-••--•-- ..: ••• --•---. ••• .. ...... . . . .. ...... . ....................... p by; ..,%----_. _ .. . ...... . . Date .. ........ ---._. Fin i fns ection.b .. l( .. ' J . „SAN.JOAQUIN OCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M 7172 3 M