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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT ............................•-- d.2 ---------------------- Permit No. 7S/ f lCotnplets in Triplicate) This Permit Expires 1 Year From Dae Issued Date Issued 14...��-2 � 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: aOB ADDRESS/LOCATION ._.... ...... ...._. .� _. ..................................CENSUS TRACT` ........ Owner's Name -----•_ .0 -- .-_ - Phone $ ` ... Address .. -...._.... ----_-- O __...-•--•-- ----------- city ..�-Q-« � ....... ---------------- Contractor's Name --- --- -:----_-••-- License :# � = Phone 's ._. Installation will serve: Res€ encs 0 Apartment House❑ Commercial❑Traller Court 0 ` Motel ❑Other..v -•-- --- 490 " c-t' Number of living units_____________ Number of bedrooms Garbage Grinder ............ Lot Size ... ..................... Water Supply: Public System and name --________________ Private.._ - ......- -••••--•............................... Character of soil to a depth of 3 feet: Sand I@ Silt❑ Clay ❑ Peat❑ Sandy Loom 0 Clay Loom ❑ � Hardpan]] Adobe 0 Fill Mater€al ............ If yes,type ............... ............ � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.i NEW INSTALLATION: INo septic tank or seepage pit ;permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I } size......f _rA'3-11.49................. Liquid Depth ................. i Capacity A del ------- _ Type c..l'! `- Material---. .:---- No. Compartments ... ............... + Distance tp nearest: Well -fd Foundation r Prop. Line �� -------------- -------••-- ••---• -moi LEACHING LINE I j No. of Lines _.......Z-------------- Length of each fine.,-.-f0------.... Total length 'D' Bax ................. -_... Type Filter Material ACA..------Depth .Filter Material ...... Distance to nearest: Well ............moo............ Foundation _. J....... . ' .. Property Line c, SEEPAGE PIT [ ] Depth -------------------- Diameter -------- Number ........__...... . ........ Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size ................................ . . Distance to nearest: Well ........................................Foundation .___........:......_ Prop. Line ............... REPAIR/ADDITION IPrev. Sanitation Permit# ------------• •---------------__---_- Date ..................................I Septic Tank (Specify Requirements). --------•.•.....................................•---......-----...__.....I....--------............... Disposal Field (Specify Requirements) __.-----------. ---------------------- ---------•---- t - ------------- --- - . . . . . (Draw existing and required addition_ . ..o.n 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.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, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed . .. . ............. -------------------------------------------------- Owner BY ------- - •--- Title r n owned FOR DEPARTMENT USE ONLY' !. APPLICATION ACCEPTED BY --- - ---- ------------ , HATE -......... y-7a BUILDING PERMIT ISSUED --------- •-------------•- -------------DATE ...........---------.....--... ADDITIONAL COMMENT'S ._..............................................•-- ...............................----------••-----------. -• ---------------- ---- --.._----------------.._....._..__..._...._.....-•••-...-- ---- ._......-- ................... p Y ._.....................--------------------------- ---------- Date .../: — `mss.._....... EH 13 Final Inspection b 2a 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M