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FOR OFFICE USE: APPLICATION'�,F SANITATION PERMIT ....... ....... Permit No. .7 ". (Complete In Triplicate) ...__.................................................... This Permit Expires 7 Year From Date 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATIO I �O� .. 64w.4Fl .......CENSUS TRACT .......................... Owner's Name .......... ....... ---•-------- ......................... Phone 4-7p.'.Z6._7-{4....... Address .................. -----W. r N Cao 4n1 ...c....... City ..... ..... . . .... Contractor's Nome ................ .. . •----0^'s.i....`! c_.....---_----....License # ... Phone Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other ............................ --------------- Number of living units:.-T...___ Number of bedrooms .12.....Garbage Grinder ------------ Lot Size ................ Water Supply: Public System and name ........................................................._.....................................................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [] Gay Loam Hardpan ❑ Adobe B'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 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size...........____------------------------- Liquid Depth __.................I-----_� Capacity ---------------- Type .................... Material.----................. No. Compartments ................. Distance to nearest: Well ....................................Foundation ...................... Prop. Line ......................N LEACHING LINE t J No. of Lines ------------------------ Length of each line-------------............... Total Length ............................ m 'D' Box ....._. .... Type Filter Material ....................Depth Filter Material ------.-__..._-_.._.-------................. Distance to nearest: Well ........................ Foundation _-__. Property Line - ---•---•-•----••-•- -------•---•---•-------- SEEPAGE PIT [ 7 Depth ............ Diameter .......... ..... Number ............................ Rock Filled Yes d No C],o Water Table Depth .................................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. line ...................... REPAIR/ADDITION(Prev. Sanitation Permit#............................................ / Date ._.---..--------._•..--.-----._.-_ pt (Specify Requirements) ------------------------------...--•-•---._.....)_ ....._.......__.._..._...._.....---.... Disposal Field (Specify Requirements) -- ._..--- s � - 33.�r RrAI ... .. .'.. . ......................................................... y / //, +..�11��-y .S.....&(4....-• 4[ / ` flf{ r° ---_---- -?r?e' 5....... (Draw existing nd requir- addition o revers si el 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 San Joaquin Local Health District. dome 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 ............... ..................... Owner BY •.... .................. ....,__ .. ---- -------------------- -------- Title .. .-. . .._.1.:._ .............. --•-•--..__..._._... --•-----..... . (If of er than owner) R' TMENT 115E ONLY APPLICATION ACCEPTED BY ...._._ ........... DATE ...... ............ BUILDINGPERMIT ISSUED ----•-•• ... . ..... . .... --- ----- ......................................._..-.-.........DATE ........................................... ADDITIONALCOMMENTS -•---• --.. .... _.•. .......... ---•••--- ...................................... •--------------••-••-••••-•....---••••-••----•--•---••-................_ ............. .............................. . .......... .............................----------._._... .................--------.._..-............................................... Final Inspection by . ............................................................................................ ... ! C_ ----------- SA JOAQUIN LOCAL HEALTH DISTRICT E, H. 13 24 1-'68 Rev. 5M 7172 3 4 1