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trpFOR OFFICE11SE: '. I APPLICATION, FOR,SANITATION PERMIT . ..... ............................__,'......... ' (Complete in Triplicate) Permit No. _...._....� 7�tCZ .----.- This Permit Expires.1 Year From Date Issued Date Issued .................... ! i Application is hereby made to the San Joaquin Local Health District fora 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 ,....... _ .. ' :_..�!'.P......................... .................CENSUS TRACT Owner's Namer,.........:--..• ................•-•••........--- Address ._._... ................................................................Phone .. _.. ��?.._1.4..�........................••---.... City Contractor's Name ...,9..;,� ...................•-•-•--•-•-•••-••................ ........................................ .....License #.V-;7..5 'Q? Phone Installation will serve: -� Residence Apartment House 0 Commercial❑Trailer Court ._.... _._..__ x . Motel ❑Other — .r...........��, .. ., _ .., Number of living units..../....... Number of bedrooms ._-_....Garbage Grinder .............kl Lot Size �1..., ...�..- �i , , Water Supply: Public System and name ............................•--•--...-------•-_....------w......_ __.._...-.• -- `- ••--____.. ..........Private Character of soil to a depth of 3 feet:; Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type --------- .................. (Plot plan, showing size of lot, location of. system in relation to wells, building4 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 TREAT . MENT [ ] SEPTIC TANK /t 5 f ] Siz®---�',r��..?�'`�................... liquid Depth .---.�..�.... Capacity .4.C7-6..... Type p1eA4 Material._.... Na •.--. . Compartments Distance to.nearest: Well -. / ; ...... /�- .............. ---.-Foundation .�4?.........:.....Prop. Line ..a ......... LEACHING LINE [ ] No. of Lines .............. Length,of each -iine..._,f�d-�- Tata! Length D' Box Type Filter Material / xa� "D'epth�Filter Material ---.... YP Distance to nearest: Well .......... Foundation .............. Property Line p Pro e ...-d............. SEEPAGE PIT [ ] Depth .... Diameter. ..........:.... Number -- Rock Filled Yes 0 No ❑ I Water;Table Depth fi __.........Rock Size . Distance to nearest: Well................................ Foundation Prop. Eine .................... I REPAIR/ADDITION�(PreV. Sanitation Permit�# , ��.: ...--................................. Dare .................................. r Septic Tank (Specify Requirements) ........ ..... ..................- ................................:...................... .............I................ Disposal Field,(Specify;Requi►emer1ts) ._..---...--•- ........................................................................................•.................I......................................... ...............................------------.............. ` '--- ` ...--_...- . •-- ........... <4, (Draw existing and required addition on reverse side) I hereby certify tl of I have prepared this application and that the work will be done in accordance with San Joaquin t County Ordinance's, State Laws,.and}Rules'and Regulations of the San Joaquin Local Health District. Home owner or licert. sed agents signature certifies the,,#allowing:' °'l certify that in theperformdnce of the work for which this permit is Issued, I shall not employ any person in such man ee as to become subiec! "orkman's Compensation laws of California." Signed _... r..Z : Owner BY , . r - ..----••----•... Title . ( other than owner) .............. R DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY- .. Y -:. _• -- - --� - BUILDING PERMIT ISSUED • ••-•-•........-•----..... ... ...-- •........................••-•-•-- ....•••... --.....-- •-•DATE ADDITIONAL COMMENTS •.......• -..........._.... ...............•......:.I...................----•-•••. -•---------.........--•-•.......... ............. ------ ............................................................,.._- .................................. ......... . ....... .........._._....................... ............. ........................................ ........ .. ---•....................I......_._..._........ _ Final inspection by: Date �7 .. .. SAN JOAQUIN L L HEALTH DISTRICT E. H. 13 24 1-'68 Rev. 5M ,..,