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FOR OFFICE USE: ......................................................... APPLICATION FOR SANITATION PERMIT 7'V ESl F _.._..._._ ... . (Complete in Triplicate) Permit.No. .............:....... ...._.....-•......... •............. Date Issued . .................. j ........ ........ This Permit Expires ? Year Frons Dafe Issued Application is-h'erleby made to the San Joaquin Local Health District for a permit to construct and install the worts herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ../67eQ11i�/...................CENSUS TRACT Owner's Name ...//.N�...-_ f� .................................................... .... ............--•-_........- ...._ ...... .,.. Phone .................................... Address ... ` �.S��Y-l✓ ............city ..............� .._. - Contractor's Name __ , ! T ♦.F,G�:, cs .€z� . .,, ! ...................License #ate,4473... Phone Installation will server Residence C7 Apartment Housefl Commercialpraller Court ❑ Mate) ❑Other__ •%1' -S;ti:__-.......... ' Number of living units:_.._..-_-__. Number of bedrooms -_•__•_.....Garbage Grinder Lot Size �l,/�..�c..,�� Water Supply: Public System and name � - .,zu- ............ - .........................Private ❑ Character of soil to a depth of 3 feet: Sand o Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobex Fill M6terial .......-.... if yes,type............... ............ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) N NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK) ] Size........ -•--------------• Liquid Depth ._...;�Z.`............. $ f Capacity ._/200---__. Type _# -QCs * Material A t, . e'•KAENo. Compartments Distance to nearest: Well ...............Foundation ...L.f?.......... _.. Prop. Line ......... LEACHING LINE ) ] No. of tines ------ __ Length of each line... ` r ----------- 9 � � �............... Total Length .._-5AP... � ' o� D' Bax i---- Type Filter Material .. ]X,jw�-.Depth .Filter Material .../X............-------------------•-}� rr . Distance to nearest: Well ..... Foundation .............. Property Line SEEPAGE PITi [ ] Depth .-.,��---..... p,pmeter ...... Number Number _.._....._./..-•--- --_---- Rock Filled Yes � No 0Water Table Depth _._.. r ---------------Rock Size ....�.r2-P.......... Distance to nearest: Well ---/.fir....................Foundation .._,ff?.......... Prop. Eine ..... -•-•- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .............--................... ) + Septic Tank (Specify Requirements) .............. Disposal Field (Specify Requirements) .....________ _ ••------- a {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 Regsrtations 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'winch this permit is issued, I shall f not employ any person In such manner as to becom blest to Workman's ompensation laws of California." F Signed ------ - �- -•- '�� '------------------ Owner BY --- ----- �t�i '................. Title -- �..�. (If other tho owner] FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY _____---- ___ a,----------- ------------------------------------------. . DATE .....�. .� --76--------- BUILDING PERMIT ISSUED ............ --- -- - _ - _-- -- DATE - _...-----•..__. ADDITIONAL COMMENTS ---------------------•-••------- -- --------------------•----------------------------..........................................................-------------------------------- Final Inspection by: -•_--- ......Date --1--Z.- Z ... EH 13 24 1-68 i�v. SAN JOAQUIN LOCAL HEALTH DISTRICT g/.74 3M