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FOR OFFICE USE' APPLICATION FOR SANITATION PERMIT ...................................................... (Complete In Triplicate) Permit No. ..7 ................................. ._-•----......--•-•--- , V`1' i' \\ Thls PeDate Issued ... rmit Expires 1 Year From Date Issued g: ..7 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 Regulotionso JOB ADDRfSS/LOCATION� .. ..<..P �.3................�._... .................CENSUS TRACT .......................... Owner's Name ...-..�L.[.l�G� ...�.t......... . .. PLifotne .i�l�3..-d�7w�� Address 1711... ...:0!.. ----.....................City .... <`t t................................ Contractor's Name ------ . ... s :..............License* ...7 /..73. Phone Installation will serve: Residence)gApartment House Commercial QTrailerCourt fl Motel ❑Other ............................................ Number of livingunits:__.�---- Number of bedrooms .-.-. .. , �t .--Garbage../G�rinder ............ lot She ....c�fQ.....,n.......?�......... Water Supply: Public System and name ......----4!2w -.--- .( rte ........................._.....................Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom Q Cloy Loam Q Hardpan❑ Adobe 91 Fill MGterIoI ............If yN,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 I ] SEPTIC TANK P4 Size......t'X.s`.ar......It.............. Liquid Depth ....fZ.z.............. Caparity/..Z-eE'-----. Type 1.�i 4C.. rlMaterial...414 *� 1o. Compartments ............ Distance to nearest: Well ------ V.. ✓-ate.........Foundation ....1 e..�....... Prop. Line .......A.Z....... LEACHING LINE No. of Lines .-......./......-..... Length of each line._...lie............ Total Length /G?.tP.'......... 'D' Box ...../-... Type Filter Material Depth Filter Material ::....,......Z.V1............... Distance to nearest: Well ---- Foundation ..... .1P.t......Yoperly )tete .......rt'.......... SEEPAGE PIT Depth ..... .. Diameter ..3.b....... Number ........../................,.. ,may Filled Yes ja No i0' Water Table Depth .......... _......................Rods Sire ..........Zr7r............. Distance to nearest: Well . .............Foundation .....1.,Q.:!..... Prop. LMe .....1.5 .........i REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Dote ..................................) SepticTank (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 wRl be done In accerdance wins San Jeagvin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health DisMct. Hem* 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 pwson In such manner as to become subject to Workman's Compensation laws of California." Signed ....... ..../.. . .... ... ...... ...... Owner By --.--.. ...... .^rli�. . . ........................ Title ........ _._..... (If other than owner) DEPARTMENT 4% ONLY APPLICATION ACCEPTED BY .. 02. .... .. L.................................................. DATE .__ : .:.� 77. .:: BUILDING PERMIT ISSUED .........I.........._ ._........................... ............DATE ...... ................................... . . ADDITIONALCOMMENTS ........ .. _........... ...... ....... .--------------_............................................................................................. _...__...................._... ...................._ ..................................................................................... ......................................................... _..................4. 4SAN ...... L... ..............I.................. .......... ...... .... ......... . � 1... Final Inspection by: .--.... .........._....Date : ..... EH 13 24 1-68 lie OAQUIN LOCAL HEALTH DISTRICT 87)1 3M