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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT:- t-- 7S`' y ........................•-••- - Permit No. IlCompleto in Triplicatel ..................... L x ..................................__........ ••.........................................._-........... This Permit Expires if Your From D.ah 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/LOCATION ....533...•_.2�re. .........................................................CENSUS TRACT ...................- Owner's Name _..-------- - -------- ti.r ...... - -•. .. ...... ..... .. ......,_,.._.._.,........::. .......... _Phone — lea Address _ ._. . .:. ....City ........................ Contractor's Name 4 �3 36 07 L�.._--- � ....•.. .........................License :#` ��'�.....�..... Phone Installation will serve: Residence 0 Apartment House 0 Commercial❑Trailer Court 0 Motel ❑Other-............................................ Number of livingunits-_...F Number of bedrooms _ b Garbage Grinder ...._.. -- ... size ..............1�_ Water Supply: Public System and name ----•------•-•--•................ �. ---._....T._._ ...... Private ❑ .. .. ... .. .... ......................P i #e Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan 0 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 or seepage pit permitted If public sewer is available within 208 feet,) PACKAGE TREATMENT j SEPTIC TANK ] Size................................................ Liquid Depth .......................... Capacity -•-•---•--!----- TType .................... Material...................... No. Compartments ...................... Distance. to nearest: Well ...................................Foundation .----------._......... Prop. Line ......................Vr LEACHING LINE j ] No. of Lines .__.. ------------- Length of each line............................ Total Length ............................ I V-box::.......... Type Filter Material """=.__--....Depth 'Filter-Material .............. Distance to nearest: Well ........................ Foundation ................. Property Line --------------- ........ SEEPAGE PIT { ) Depth . Diameter Number Rock Filled Yes ❑ No Q I Water Table Depth ---------• -----•...............................Rock Size _.., ......................I— t Distance to nearest: Well ....-----_-----------•............... Foundation ... ................ Prop. Line .___......... -------- REPAIR/ADDITION (Prev. Sanitation Permit# .....-•- . -•-- -.4-,, --------- Date .................................. ._ e -- Septic Tank {Specify Requirements) ------------- r . ..__........ ....... Disposal Field (Specify Requirements) ,_.. --fes -——------- --•-------- -------- --- --------- ------------- 1 �'h -- 4 � 4.c�-[ ---.................................... -----------••-•---- --- (_Draw existing and required addition on reverse'side) I hereby certify that I have prepared this application and that the work will be dons in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;Dtstrict. 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 ---------• --------------- -- I Owner By ---------•---- -- V= (if oth hon owner) --- .. Title ....... --------- - �.........-._...--•------- DEPART ENT US.P ONLY APPLICATION ACCEPTED BY ---- -- -- - BUILDINGPERMIT ISSUED -.-....---••--- - ------------- ------- -------------.------------.------....-_---------..,-DATE ........... .._.------------ ......... ADDITIONAL COMMENTS .......... ............. •-• - ---------------------------- _... I ---- --- ~. _ - --------------------------- ------•-....................... r....... ......I . .. -•----------------.._...... Final Inspection by:�_ .--_.Date .... EH �3 2h 1-68 Rev 5M SAN JOAQUIN LOCAL HEALTH DISTRICT ? 8/74 3M