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FOR OFFICE USE: -•- .,_r......,. APPLICATION FOR SANITATION PERMIT )Complete in Triplicate) Permit No. ............ _... ......Yi.........................................••.... This Permit Expires 3 Year From Date Issued Date Issued ...`1.......:._.S Application is hereby trade 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/LOCATIONS 4 f.- ...` ..-..,.-.. r� ? ., , .......................... ......CENSUS TRACT ................ ................. Owner's Name .......70, ._. .` ........................................................................Phone 'r. Address ----� 900 /.....-..0c-sr-----• --•• .. Ci L Contractor's Name •.-3C,"f M�.411-./31.1. e�. �lmnmo,License .... Phone Installation will serve: Residence❑Apartment House 1P Commercial❑Trailer Court C3 Motel ❑Other. Number of living units:.------ Number of bedroomsGarbage Grinder ..�!..--- ............ Lot Size ............................................ Water Supply: Public System and name .._...._._. . Private ❑ Q........... .......... t.. . ............_.......------• Character of soil to a depth of 3 feet: Sand Silt. Clay ❑ P ❑ Sandy Loam Clay loam ❑ Hardpan❑ Adobe❑ Fill Material ............ if yes,type............... i (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 200 feet,) PACKAGE TREATMENT j f SEPTIC TANK { Size.......1J6_0...©- ............... Liquid Depth .........---.............. Capacity ...lit,0------ Type ! ' MoterlalG��-t' No. Compartments ._ . . .... .. Distance to nearest: Well .. ,'t y¢ ---Foundation ..../.Q..._......... Prop. Line ..A.'...... LEACHING LINE j l No. of Lines ------- ------------- Length of each line-....3d7kk ----- Total Length .....7..0.............. 'D' Box ..A------- Type Filter Material •-•)-#%.........Depth .Filter Material Distance to nearest: Well . _ 1&.-t.._--_--- Foundation ............... Property Line ....�.J......_....... SEEPAGE PIT ( l Depth ..... .. Diameter Number .... `_..._........ Rock Filled Yes ❑ No 0 Water Table Depth ••-•-------- ........Rock Size ------t Distance to nearest: Well ........................................Foundation ..... Prop. Line IEPAIR/ADDIT16N IPrev. Sanitation Permit# .......... ------------_----------. Date ---.....-- ._._.._-• t Septic Tank (Specify Requirements) ..............04016..................... Disposal Field (Specify Requirements) ---------------- - (Draw existing and required addition on reverse side) 1 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. Nonce owner or licen• sed agents signature certifies the following: "I certify that In the performance of the work for'which this perrisit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." . Signed •------- Owner ✓� ,�l �y', BY - C �-----------------------------------.. Title ....�-.� . e- ---------------------------- (if other than owner) FOR DEPARTMENT USE ONLY .APPLICATION ACCEPTED BY ... -------- ----------------------- ----••---•--------------------------•------------------------ ---... DATE ._.-. �I,�:��: .:...... , - BUILDING PERMIT ISSUED -DATE .............•--------------- -ADDITIONAL COMMENTS ----------- ------------------•- --------- ---- - --- ..----------• _. ---------- Final Inspection by: - _ • • - ------- ------------------------- ................................. --- - --------•-----------Date ........-...... 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M