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FOR OFFICE USE.- APPLICATION FOR SANITATION PERMIT Permit No. .76 ------------ ...... IComplete in Triplicate) ,-. :3 This Permit Expires I Year From Dane issued Date Issued 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 .. .__ ..- 1 ........, o �� .....CENSUS TRACT .................... Owner's N ............ ... _....�t�;_.�.� � -'' .Phone ..... ............................. Address x.- ._..._._- 3.ca_ . .. T...city ............................. Contractor's Name ..License 94Re.,�,� 7 ,� •• . � /.. .. Phone . Installation will serve: Residence p Apartment House 0 Commercial railer Court Motel p Other Number of living units_____________ Number of bedrooms .___Garbage Grinder Lot Size ... .:............ Water Supply: Public System-and-name:-::-. '- - - ��fr.,c�-c.:r:_-- - - . ........_.....---•....................:...................Private ❑ Character of sail to a depth of 3 feet: Sand Silt CIa Peat Sand I.oam Clay Loam ❑ Y ❑ ❑ Y ❑ Y ❑ � a Hardpan p Adobe t] 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 :permittedrif'public sewer is available within 200 feet,) it PACKAGE TREATMENT { l SEPTIC TANK r� l Size ----------------------- Depth Liquid ...... Capacity .020'0....... Type 60.4- Material_ . No. Compartments_. . . ......._i i Distance to nearest: Well ...... ...........Foundation ... _.......... Prop. Line _.-45............. LEACHINGLINE ['JNo. of Lines f _---�- sz t- -- Length of each line-.. ......-- ---- Total Length ................. t D' Box Type°Filter Material a,.-Depth .Filter Material ........ Distance to nearest: Well -41 ....... Foundationl�............... Property Line .. ... ....... SEEPAGE PIT [ J .__. '""�"f3epfii�"�"�::�":':.':'-`-..._.D_...,,_,... � : . iameter ................ Numbers---------------------------. Rock Filled Yes ❑ No Water Table Depth ......... .................... ..Rock Size .. Distance to necrest`Well ................ ....•- ----------.......Foundation .....__.._.._....._. Prop. Line ...................... . REPAIR/ADDITION(Prev,-Sanitation-Pe-rmit ............ ...................... Date ...:......................... . ) Septic Tank (Specify Requirements,.__................. c Disposal Field (Specify Requirements., .,.- sl .r,_ ------------------------------ ---•---------------• � i ti - ------------------------ __..... -----•---.' ........:........•-••----......... ................. (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;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"comq4ybject to Workman's Compensation laws of California." Signed ------- Owner BY -- --- -- ---- than o- -- (If other --•---••-------- ------------ Title .... � -��-z ` wner, � --------------------" ---• FOR DEOARTMENT USE ONLY ,. APPLICATION ACCEPTED BY BUILDING PERMIT ISSUED _... --'__ _ _._._ .. ------------•--•----------------•-- --------------------------- DATE .._.'.._ � r - ... .7.---..... ------•- i - __--- --• ----DATE ------ ------ - ADDITIONAL COMMENTS ----------- ---- ---- ----------------------•------------------. --------------- ------- -------- ---------- final Inspection by: . -------------------------------------------- ---•.Date .. T . ' 13 2h1-68 itev. SAN JOAQUIN LOCAL HEALTH DISTRICT 87)1 3M I e