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FOR OFFICE USE: Y SJ.. APPLICATION FOR SANITATION PERMIT .. " ............... . ...... ......�....... ..... (Complete in Triplicate) Permit No. .. .—_f` .... ••---...... ...... This Permit Expires 1 Year From Date Issued 3.'� Date Issued - s..741 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 ADDRESSAOCATION . --.--. dl�7 �1 p ��41 ........CENSUS TRACT .......................... Owner's Name .---.... tlap hb67�Address ._... ... � ............ --------------- City .. . .. . .. ....................................... Contractor's Name .. .......... .. ... c ..._ 'B /-----.-- ,--License #D�SY J' ..... Phone .. - -.-.- .. E Installation will serve: Residence ❑Apartment House 0 Commercial ❑Trailer Court ;❑ Motel ❑Other Number of living units; . .-L.- . Number of bedrooms ----/------Garbage Grinder . _ ) Lot Size ..... .r."o../14-S. ............... Water Supply: Public System and name .....................-------------_.----.--..-.---....__..-•--•-•-- tom..._...----------.-Private ❑ Character of soil to a depth of 3 feet:- Sand Silt❑ Clay ❑ Peat❑ Sandy Locirri 0 Clay Loam ❑ Hardpan ❑` ,\AdofibF p--lFill Material . If yes, type ........ .. . .............. 1 (Plot plan, showing size of lot, location of sysemirilrelation 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) ol PACKAGE TREATMENT ( ] SEPTIC TANK Size.........-5-A'If-------- ....... ..... liquid Depth -_s t ...... Capacity /,i� _ Type -------------•--.... Material...L,p-N•� -- No' Compartments Distance to nearest: Well . . ....... ... ............----JFoundotion ..../0.A_ ....... Prop. Line .. ............. ^L? ' � / ` 1, LEACHING LINE No. of Lines it Lengtho f each line ._._s,?0.._... .... Total Length ...?4................ �1` I -,i'_ 6 e ll 'D' Box ---... Type Filter Material Vo.-.r-k......Depth ;Filter Material ...............................r Distance to nearest: Well ._.. .�.... tisFoundation ../.Q.-.,t".—I Property Line .. ....::...........s SI=EPAGE PIT ( ] Depth ..____- Diamit e ................ Number _ """"" "�...._.,.....__ Rock Filled Yes;V No ❑ D� iAl Su u+ Water Table Depth ........... .. - Rock-Size Distance to nearest: Well ..... ..............................Foundation . .... Prop. Line ........_,..........IC? I .+ i REPAIR/ADDITION(Prev. Sanitation Permit# ........ --�.. _..... .-----------.•�.-....Date ...... Septic Tank (Specify Requirements) 1...... . ------------ ----------- s •r.-'�-... . Disposal Field (Specify Re uiremen� � _... ........ - !_...- ------------- R • a ----- ------- . ... ..... ...... (Draw existing and required addition on reverse side), I hereby certify that I have prepared this application and that the work will`be`do a 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 "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 lows of California." Signed .... . ........ ......... ... -- ------•------ ------------------------ Owner ., 00 (If By .. • o#her t owner)-.... - --- -----• . . Title --- f00 1 FOR f RTMEN7 USE ONLY APPLICATION ACCEPTED BY ------ -- . ... --- DATE BUILDING PERMIT ISSUED ......... I----- --------------- .. .......DATE . ........ ............. ADDITIONAL COMMENTS .... . - . . . --------- ----•----------•-•----•............. ............................ ................... ................... .. ...... . ... .. -----.---- ----- ---` ►. ----------- --• Final Inspection by: ....... - --------- ----•- ........ :.__�..-......... _--------------------Date ..._.�f:�.y�l��,7 JOA UIN LOCAL HEALTH DISTRICT 13 24. E. H. . ::1-'68 R : SM..__.. .. °�. � ' '.` '.. _. ;.. . 71723M.M