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FOR OFFICE,USE: APPLICATION FOR SANITATION PERMIT • p �7-�-6 (Complete in Triplicate) Permit No. ..................... Thi: Pereedt Expires f Year froth Dole Issued date Issued ...J .....7J Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the wok,herein described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATIO I `C� .�..... . .. ......................[ENSUS TRACT ......................._.. Owner's Name - .-.. ....................... ......... ..... ......Phone . . ........... ...9.. �._......... . City .. ...................... Contractor's Nome .... License Phone installation will serve: Residence O-Apartment House Commercial []Troller Court ] Motel ❑Other .............................. Number of living units:..,-.I..... Number of bedrooms .. Garbage Grinder Lot Size Water Supply: Public System and name .............. Private Character of soil to a depth of 3 feet: Sand❑ Silt.[ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ®___ Q` i Hardpan (] Adobe Fill Material © ............ If yes,type............... ............ -14 � (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 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ' ' ' �� Size . ._. "1.. ... '.._..�.._........... Liquid Depth .......................... -.t�....... Type ``"`�.^ Material.... No. Compartments Capacity j. Distance,to nearest: Well .......... . Foundation' l..Q. Pro Line ..:�.(�._....; . r ...._..__ LEACHING LINE No. of Lines _...._.. + ---------- Length of each line...----• _�./fi.:_.. Total Lenth .._:.-- - 'D' Box .......I__-.. Type Filter Material .....SX1 ......Depth .Filter Material ................ ................. Distance to nearest: Well _...:- : a, -_ Foundation ....../.s4-. ,• Property Line f [7 Depth ------.J._0..¢..f- v ------ ..tet . Number ----.... —.... .....-. Rock Filled Yes } No C] Water Table Depth ................yb..Vtt.................Rock Size ..-II-a.. ..3.../, ._. Distance to nearest: Well .-----------i..ia):�... ---. ....-Foundation --�* - Prop. Line ... ...... i REPAIR/ADDITION(Prey. Sanitation Permit# ..._.................................. :._-- Date .................................. --•-•.................) Septic Tank (Specify Requirements}.-------•---•-- -- ..................I.-•---.....----•-•..... Disposal Field (Specify Requirements) ................ ............ ........ •-----------•••-...................................... . ---------- -------------- ----- ..----.................................. (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the woNc 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 liten- 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 B (If other than owner . Title Y --- ---- -------------------- . . . ..........r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __�Z_ --- .-- -• v . . -- ._. DATE .., ,:... =3 — .. ---------- ADDITIONAL PERMIT ISSUED ........ - . . , .: ----•-------- --- --•--------•. -- .................... _._ ..----DATE . ADDITIONAL COMMENTS ---•-----.•----------------• - -- -- _...._.... ----....._.._. ---------------------------------• -------••-----••------------ - - Final Inspection b _ --- .---.---:-.-•.-. Y -- ---- .- -----�--- - ............------------------------------------........Date .c�.�.` Ef•3 13 2a J.-6f3 � 7................ 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 -- ti