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FOR �WFICE USE: <� APPLICATION FOR SANITATION it tM1T (Complete in Triplicate) Permit No. . 7J i/St0 - -- - ----- --- --- -------... This Permit Expires 1 Year From Date 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 10-60---- ,� �� /� ---_CENSUS TRACT ---------...-------.. Owner's Name _S.M,.--/.'��...G9c.2.-L.�Q------------ __. - Phone - Address _ _-J?Q.s..aok . --,�- ----- - - ------ City Contractor's -✓/�/ reLCT-arr----------- Name .. �� E��E"s .License # ZSVI7& - Phone Installation will serve: Residence p Apartment House❑ Commercial erailer Court ❑ Motel p Other � r,(1i Number of living units:.Ao10__ Number of bedrooms 112:..-Garbage Grinder/1P__. Lot Size .1D/XVie1ej.- Water Supply: Public System and name ._----- -------.----- ----- -..Privat 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, buildings, 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 TREATMENT [ ] SEPTIC TANK [ ) Size___6- ..Z/ Liquid Depth _. 3.............. Capacity TOot7..__.. Type ..lsiwp... Material._49 vCW4 cr No. Compartments .......... Distance To nearest: Well /r9Q...__----______-----Foundation ../Q..--__----- Prop. Line ..,5 ............ LEACHING LINE [ ] No. of Lines .. Length of each line.__.4042.,' -_..- Total Length 3 v 'D' Box &V.:_- Type Filter Material 1.�XJ ,_. Depth Filter Material Distance to nearest: Well ../62Q..-----._ Foundation _/QProperty Lina `pv SEEPAGE PIT [ j Depth _._ .. -__.. Diameter ---- Number _.._..___. Rock Filled Yes ❑ No Water Table Depth _------ --------------------------.Rock Size ..- .... ------------- Distance to nearest: Well ----- ------------- -.._Foundation .._....._._-----. Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# .... _.----- -----. Date Septic Tank (Specify Requirements) -....._-_...... .. Disposal Field (Specify Requirements) ......-------------------------------_------.----.--.------.-_... --........ ...................--- ------------------ ------------ ------------------ ---------- -.....-. ....-----_...----._---- --------- ...... ....... (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, 1 shall not employ any person in such manner as to become blect to Workman's Compensation laws of California." Signed _..---- _ .. Owner BY - - -....( othe...tha o.._.. - ---- ...- Title . (If other er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .__...._.....c��c DATE BUILDING PERMIT ISSUED .__-------------- ------ - -- - - - DATE ...... ADDITIONAL COMMENTS - ... .................... - - - -.................................... ............ ------------ ----------- -------------------M..... ------- ---- ------------ ------------------------------------------------- ---- --------------_----------- -------------------------------------MM ------ Final Inspection by: - - -- �f = - ------ -- ..-..-...---- _� ,).�.. --^ -----------------------------._Date .-`--- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M \