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FOR OFFICE USE: I APPLICATION FOR SANITATION PEF 7T (Complete in Triplicatel `� Permit No. - 0.7 2 g —A- ----------------r--- --•----•------------- __ ----- This Permit Expires 1 Year.From Datelssued Date Issued -_-g- -I.4-_70 Application is hereby made to the San Joaquin local Health District for a permit to construct and described. This application is made in compliance with County Ordinciacte.No 549 and existing Rulestalnd Regulat onsrein I JOB ADDRESS/LOCATION° .5------ 1�'r - . - ----------- -=CENSUS TRACT Owner's Name --------Phone ----- `� --- ------------- }�/,�-•� �'- ------.... Cit -- --------------- •-----. -- Y E Contractor's Name----_ •--_-- -,, , ,'-- -f_4 S� - ---------------------License # � .��----- Phone /D Installation will serve: i Residence Apartment House-❑-Commercial OTrailet Court Mote! ❑Other ------------ --------------L -----•--------- Number of living units------1_:-- Number of bedrooms -- ' . -• Garbage Grinder Lot Size Water Supply: Public System and name --- - , - - --- ---- -- ---------•----------- ----------=-------- ----------- •----------•- ----------- --------Private ElCharacter of soil to a depth of.3 feet: Sand F] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Laam� ' Hardpan ❑ Adobe ❑ 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.) (A NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} \j PACKAGE TREATMENT -SEPTIC TANK� w l Size ---------- ------------ Liquid Depth Capacity /��-__ --- TYPe/&�°40 �---__ Material_-_046W ------ No. Compartments __•_-7—__:_.-.--_ _ Distance to nearest: Well ------------------------------------Founclatio n a-_---_--------- ----- .Prep. Line - . LEACHING LINE [ ) No. of Lines _-_--_ --_---_-_--_ Length of each `line_-- " g .,�-------+- -_--- Total, length 'D' Box Box _37_---- Type Filter Material e--�-Depth Filter;Material --- s0._�-_-__._ •--- ........ ' w.., .: Distance to.nearest: Well -------------------•---- Foundation -------------------____ Property Lime'--__-_--•---------:_---- • � , SEEPAGE PIT [ ] Depth - - --- Diameter 3sj----- Number --------Z--------------- Rock.Filled' Yes No'10 Water' Table Depth --------------------- Rock Size ----- Distopce to �nearest: Well -------------------•- -•-------- ..._,Foundation Prop. Line ------------ REPAIR/ADDITION ------------ (Prev. San itation,Permit# ---=------------�-----•-------.__.._1____ Date ---------------------_----------- Septic --------------__ __-_-_----- Dis osal Septic Tank (Specify Requirements) ----------------------------------------- ---------------- --•--------------------------=--------------•-- .,.------- — -------------- p Field (Specify Require ments) --------------------------------------•- i F ----------- --------------------- --------- =---------------- -- --------------------------------------------------- -- (Draw existing and required addition on reverse side I hereby Lo certify that I have prepared this application and that the work "will be Lone in accordance with San Joaquin ' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin- cal 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 an - ? as to become subject to Workman's Compensation laws of California." p y Y person in such manner n3' � Signed Owner ------------------ - - e I ,. By Title -- �. 4�. {!f other than owner) ...................------ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ,��-+ ---- DATE _ �./- '-'-�-a BUILDING PERMIT ISSUED ----------------------------- -- --- _ .,. _ ..� •-, - -----------------------•----------- -------DATE ----=------------------ ADDITIONAL COMMENTS ----------------!---------- -- --------- . --- -------------- ----- - ---•-----------•--------- --------- --------------- ------------------------------- ---- ------------------------------ t ,; Fina Inspection by: _ -- . __ ------------ - - -- ----------- -----------------•----....--•-- -------- - -- ---------- -------Date --.-�� ---Q---- ---- ----- --- SAN JOAQUlN LOCAL HEALTH DISTRICT E. H.,9 1•'68 Rev. 5M