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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .............................__..........-. 7S-�d7 {Complete in Triplicate) Permit No. ..:..........•-•----- ........................................... ..............................................._-....- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin local Health District for a per to construct and Install the work herein described. This application is made in compliance with County Ordinance No. 549 andexistingRules and Regulations: JOB ADDRESS/LOCATION CENSUS TRACT .......................... Owner's Name '`Y'�`1�_'�r..._ �" ......:.... Phone . ..` '., ..-50 Address ... 3�a� ... ,�. .f3.C) �'L...........City We.rX Contractor's Name . G.. C� .A�`�r.�ac �`C.e........License # Phone Installation will serve: Residence WA.partment House] Commercial❑Trailer Court C] Motel ❑Other ....................................... Number of living units:... Number of bedrooms ____._Garbage Grinder - $ Lot Size ..-�3' ._.....�r�r. ............ Water Supply. Public System and name , ............................................Private [] Character of soil to a depth of 3 feet: Sand Silt❑ Gay C] Peat❑ Sandy Loam❑. Clay Loam Q 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 I: ] Size-----------------............................... Liquid Depth ......................... Capacity -----------•---•--•- Type ............. ...... Material-- ------------------- No. Compartments ..................... n , Distance to nearest: Well ....................................Foundation . Prop. Line LEACHING LINE [ ] No. of Lines -- ..�........ Length of each lin .._.. ............. otal. Length ..... .........._..__.._._� D' Box Type filter Material --------------------Depth Filter Material ...........................................6 Distance to nearest: Well 1.�r�foundation - - -- -------------- Property Line ......6 SEEPAGE AIT [ ] De,.t x-` js .— .Diamete _ Rock Filled Yes " —idumber -- -----. , p Water Table Depth ..... .....................................Rock Size -- .•-- il,/ F, Distance to nearest: Well --__-- -------- ..- ndatio -/42------------------- rap. Line -. .....ro 4 REPAIR/ADDITION(Prev. Sanitation Permit# _........................................... Date ...............................-.1 Septic Tank {Specify Requirements) ................... ----------- ----•••... ---•----................ Disposal Field S ecif Re uir ments .... _-..-- ..... ------•----------------------------------•---•-- •-•------• -.------------------------.-------- ------•---•---------------------...---..--------•--•------------•- •- •--------..._.. (Draw existing and required addition on reverse side) ` 1 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, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ---------------------------- Owner BY --- ------- -Title �J�---------------------------- (if other than owner) FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY __ �- DATE L - 7.--�-3-------: BUILDING PERMIT ISSUED ----------------- ------------------------------------------DATE .--------.--..----.................. . _ kADDITIONAL COMMENTS ----------•--------- ------------------------------------------•-------....._. ........................... ......... ------ .......:................----------- ------------I f FinalInspection by: --------------- w. ...................-...................................... ...........Date---------........ ------._�_6............ EH 13 2L 1-•68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M