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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 6s� (Complete In Triplicate) .. Permit No. ...... ............ ............ ........•-..:..........--•-•......... P p �G _..... This Perm It Expires 1 Year From bah fDate Issued .7.. " saved -"- 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 ._....�..,�.�d._. 1'1._,��.c,dnf�zz�.,...,..la..`��s`.:.............CENSUS TRACT ................-......... Owner's NamerT................... .............. e Address . - 3. L�? G� rtcl%r -- --• ..... City _. ��Cr4� n Z ffr ............... �.... ....a.............. Contractor's Name --- F if -- , may ..License # - S7)2� Phon .a s;;. 3.!Zp_ Installation will serve: Residence❑Apartment House] Commercial❑'frailer Court Motel ❑Other ............... .......................... Number of living units:- .,� _. Number of bedrooms ............Garbage Grinder ......_..— Lot Size Water Supply: Public System and name ..............................................................................................................Private, C�} Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ .Peat❑ Sandy Loam Q Clay Loam ❑ Hardpan ❑ Adobe Fill Material ...._.....- If yes,type............... ............ Q (Plot pian, 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 ............._........ .--- l�Ts ")j Capacity ------ ------------- Type ---•-----_--------- Material.....-- -------------. No. Compartments Distance to nearest: Well ....................................Foundation ...................... Prop. Line .................. LEACHING LINE [ j No. of Lines -.../................ Length of each fine.__............... Total Length 1fy .- }`�.....�............ 'D' Box � -- Type Filter Material .f Yz.R !...Depth Filter Material .....IZF... ..........................• Distance to nearest: Well ....226........... Foundation ----/0-._`.._'�'_.... Property Line .'T./.�.....-, t r SEEPAGE PIT [ Depth --- .... Diameter Number -.--.---.Jt................ Rock Filled Yes M---No 0 Water Table Depth -----__ --------------------------------Rock Size zx-/.&......... Distance to nearest: Well ..........:YQ ......................Foundation ---Ze2_...T.. Prop. Line _ .......... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .._. ............................. Septic Tank (Specify Requirements) --- ----------------------- ....................... -------------------------------------.-..... _.__.._............ Disposal Field (Specify Requirements) ..�,a..Ca_.. . '... ••-- ...... ----- . ...................... ... J /`+/� r�� __------ __4.(f(-(.(___.. •---------------------•••.---.------ ___-_---------•-_...-----------------" -._..__..........._____....._.._._................................................_........_.. (Draw existing and 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 San Joaquin Local Health:blstrict. Home owner or llcen• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, t shall not employ any person in such manner as to becom bled to Workman's Compensation taws of California." Signed -... .. 1!!� (if Owner BY ------------ ---^�-�-- ..C. �.. title �0' (if other than owfner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .....-J -- ----- -- -- DATE 7.............: BUILDING PERMIT ISSUED ---•-- ------------•---- DATE .... -----•------------------------ ...... ADDITIONAL COMMENTS ---------- ..- • ---------------•---------•-••---- --- -------------------- -- ............ Final Inspection by: -..---------.-- Date -.- -- EH 13 24 1-68 Rev. 5m : . :::.:::: SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M