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4 Felt OFFICE USE: }- �" APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ....- �- This Permit Expires 1 Year From Date Issued Date Issue _ -.,..... 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 � d- . - .!. .i' .._._ .. - o-1/ �C_ `....... .......CENSUS TRACT .......4f Y......-•---- Owner's Name ........•2---.4....-...491,11 -3 .... _% . -- -- . .... ...........................Rhone . .. Address City !�� 3a.................. D ---.... -•-- - Contractor's Name ------------------------License # ..... .. .............. Phone ---------------........ ..... Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other -4-1�, Jr-1-7f Number of living units:..�_... . Number of bedrooms _--__Garbage Grinder .7Ld— Lot Size ..fv7. - 1Z ................ Water Supply: Public System and name - ------ --------------------------- ................................Private s Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam �[ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ) Sixe.. f /.Q.f .. .__......... Liquid Depth ... ....._..._� Capacity /ab6 ul T y p .V�af'._ Material..& No. Compartments ..............94 Distance to nearest: Well -------------.....Foundation . Q..... ... .... Prop. line _IQ_ _....._. VI LEACHING LINE [ ) No. of Lines Length of each{ line - 010 137 . . . -... Total Length .»a................ N 'D' Box Type Filter Material .. �� ........Depth Filter Material .../� --------------------------------V1 Distance to nearest: We[,[, .1. ._G... '.�.._. Foundation /U..-..... Property line _/_...�............. / J 1X / 2 SEEPAGE PIT ( ] Depth b '� d..... . Diameter ., Number . Rock Filled Yes No (:3Q Water Table Depth .... ------------------------------Rock Size Distance to nearest: WellQ� .---- Pro ......Line _fa. ...................Foundation / f P REPAIR/ADDITION(Prev. Sanitation Permit# ........ _ ._... ..................... Date ..................................1 17 Septic Tank (Specify Requirements) ~'' Disposal Field (Specify Requirements) ............................................................... ........ ....... ... .. . .. ......._.. ................... .. f ........................... ........... ............... .......... ....... .................... •----- -. .... ............ ... ... . ............. ... ......... .........-------...................................._.............. (Draw existingand 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 Son 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�Vie,,,,t9Vor�Fnan's Compensation laws of California." SignedIY `" ... ---•-• ------- By . . ... ................ ..... ..... ---......-....... ------- -------_ ... ... Title (If other than owner) FOR DEPARTMEW USE ONLY APPLICATION ACCEPTED BY 6e4,;:,- �� .. . .. ...... . ... .. .. . ... . . .._., DATE . :�`.��._.._.__....-.. BUILDING PERMIT ISSUED -. - --- . .DATE .............. ADDITIONALCOMMENTS .... . .......... ........................................................ .. .. ... ... ---- ... ............---.• .................................. ...........................------------------ --............................. ....... ..................... ...... --- ---.....----------•-------...---..-....---•..._......_. --------•.......................... ---- - --- .. ....... ..... . ---- ---.....--_......-------.---------------------....------ -. Final Inspection by: ...----- -- Date ... .- J .. ...... ............ SAN J UIN LOCAL HEALTH DISTRICT t_ E, H.13 24 1-'68'176x. 5ti1 - - - -- -- 7/72.x•,14