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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 741 , 113 (Complete in Triplicate) Permit No. ...:................: Date Issued / .............'7,6 This Permit Expires I Year From Data 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 .:... .. . . ....._-Ll.- ..-12. � �. . ............ ..... ......................... .CL...Pho TRACT..._. ...................--- Owner's Name _.. _ -__-- -• Phone Address ._...:. ...[' 'J .... ............... ....... City ................. ........ ............................................ Contractor's Name ..... ..... ... �� • , 4. License . ., Phone Installation will serve: esidence EJApartment House {Commercial;)]1'rallec.Court MotelOther..................... ...................... Number of living uniits_____________ Number of bedrooms ---- ------Garbage Grinder ............. Lot Size ............... Water Supply: Public System and name.................... .Private 0 Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay Q Peat❑ Sandy Loam ❑ Clay Loam Hardpan p Adobe 0 Fill Material ............If yes,type ............... ............ (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 it public sewer is available within 240 feet,) PACKAGE TREATMENT € ] SEPTIC TANK j: ] Size............................................: .. Liquid Depth ................... Capacity Type ..._-_-- Material. No. Compartments . ..- Distance.to nearest: Well .................._--............-Foundation ............... Prop. Line .......... _. LEACHING LINE [ ] No. of Lines ------------------------ Length of each line..........................i•. Total Length ......................__P .......`� X / 'Q' Box --.--..._... Type Filter Material :............Depth .Filter Material ..._..------- .............................. p€stance�tWXZOrelbmeter garest: Well _....................... Foundation ._...__..........F.:.--- Property Line ........................1 SEEPp _ (j Depth 'J� ..--••..----•---`;Number ____.- ......_..--•_--_y. Rock Filled Yes No �`l _ a Water Table Depth --------- .......................... j�( Rock Size :.z�... ... Distance to nearest: Well :....:...............Foundation --- .............. Prop.' Line--_....__.._.._..:-••-- REPAIR/ADDITION(Prev. Sanitation Permit# Date ..................... -•----------- -- ..... ) SepticTank (Specify Requirements) ............=........-•.......................:-:................................. ............................ ----.................... Disposal Field (Specify Requirements) ---------•----------------------------- .......................... _..-----•----------•-.. ....................... --------------------------..........................:........................................ (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that tl�e work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health DiaMcf. 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 become subject to Workman's Compensation laws of California." } Signed .----- Owner . _.. .....--•-----... BYIf Chert an -a- r)�� .... ......•....._ _ Title ---- --- ------------ -----•--------------._....- ......... :1 r It E0aRTMCNT oMLY APPLICATION ACCEPTED t3Y ---- --------- ---------- - DATE . BUILDING PERMIT ISSUED ...................... ------ .____._: .....,__:._.. DATE .... -----•- ------ ................ ADD1TiONAL COMMENTS _____-_-. �r-3 P•-•_ F__...._.-__ _ �4 .--- __.... Sb_.._... _cTn f. ._la+��.____ --.-- f---•-------------------- ------- Final Inspection by: - -------------- -_•-.----------------- -•---- ---.._Date ...... ....d./_� . .._...._...._... .EH 13 24 1`68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M