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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Y77 ............................ Permit No. ...... ......_... (Complete in Triplicate) This Permit Expires ] Year From Date Issued Date Issued 9.450411+- _ ....................................... ._..._.....• 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/LOCATION :._.603-. &...c`'__1=1s'�..�.-'..............................------ .: •-::,._..: ..........CENSEI$ TRACT-'.............:....._...... Owner's Name ._.. ...............a to??.:. Wil 1@]C...........::•-...........................................:..................Phone ...n•2_478......... 4 Address _441.e............... .......................................•-•--••-•---.._.------------.........City ...c�.�OC.�LaQI7�.............................._-=--•-•.......:......... Contractor's Name ---1ke.1_5...� P .D_..t ...ae r:'rie.e....................License # 177x83.....:.. Phone ..lfl']-�52?6...... I Installation will serve., Residence ®Apartment House C❑ Commercial []Trailer Court ❑ Motel ❑Other Number of living units:__ii........ Number of bedrooms ......2...Garbage Grinder ... Lot Size F....._.1,00 _]C-,1,50,•„-•--,•-•• Water Supply: Pr,tilic SKstem_and name •-:•-••..........::............•-•...........------------........------.......-----..........----......_......_Private ❑ (Q�� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ' Peat❑ Sandy loam ❑ Clay Loam ❑ '”" Hardpan ❑ Adobe eq Fill Material ...._.._.:.. If yes,type ---------------------------• (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 200 feet,) r PACKAGE TREATMENT. [ I SEPTIC TANK:t I Size................................................ Liquid Depth ......................... CapacityType .... Material...................... No. Compartments Distance to nearest: Well ....................................Foundation ...................... Prop. Line .............. LEACHING LINE [ ] No. of Lines ........................ Length of each 'line.......... Total Length ....._.._._..............:.. Box Type Filter Material ..Depth Filter Material Distance to nearest: Well ........................ Foundation ........................ Property Line ..................... SEEPAGE PIT [ 7 Depth ............::-------- Dlomete Number Rock Filled Yes ❑ No ❑ Water Table Depth ..:.._.__..Rack Size ................................ Distance to nearest: Well ...........:...•-----.._....::: ::.::..:Foundation ............... Prop. line ...... ...... REPAIR/ADDITION(Prey. Sanitation Permit# ............................................. Date ........-... ..................... Septic Tank (Specify Requirements _.......30 t of leach Eine.'and._a---� . -„ _-- . Q•_ . ........ ....................... Disposal ...... Field (Specify Requirements) ---...•.................::.........................••---.............--•----------..........---...------•-----•. .......................................................... ...... (Draw existing and required addition on reverse side) V 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 icemsed 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 L. E. Ikerd Contractor i (if other than owner) } FOR DEPARTMENT VSJ ONLY APPLICATION ACCEPTED BY .......... Zf................... DATE ._.:`'.:....... BUILDING PERMIT ISSUED r r'------ .....DATE _..._..............., .. ...----•--- - ADDITIONAL COMMENTS ...............,tp .. _,.-- rC.� • • �/� �._u.fir ....... :. ..--••---••...----...•-•........................:........•-• - ----------•-- •--•----------------- _........•-••- i .......................................... ------ :_ _.._......---------------••------•-•-•-. .......... • ............... :...................... .......... ... .......... _:_.. . . ... ...._. Final Inspection byL .............................................................•.......Date .............. ....._.. ..._. i4 SAN JOAQUIN LOCAL HEALTH DISTRICT f• . .__.. ..o_ �.._ . a _ _.. _. . c u 13 24 , +tee o_., cal "r �s. 7/72 3 M