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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Ptmri 73_4,11' (Complete In Triplicate) . . This Permit Expires 1 Year From Date Issued Date Issued ...7;..3� 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. SID and existing Rules and Regulatlosnr JOB ADDRESS/LOCATION . . _' I),.. M (}.-..h.4.w'......hn .. .. ........ . .....CENSUS TRACT ...... _.. Owner's Name .... ....I..�.!V.iV•.. �^.'. Cr.......................... ...................................Phase ...-.............. ... .... Address _ - .... ........: .. _ ..... . .1• .�v,ct................................. ...........City ..:T1:"i .A>.` .a ....\..xA..!.k.�.-................» _- \ - (� C, Contractors Nome .. .. �.) r_A,s.N..e� .-�b1�.-dC1.1.............License #Z5. 34.3... Phone . �.... � ._. Installation will server Residence Apartment House[] Commercial ❑Traller Court Q Motel ❑Other ..........................................m _ Number of living units: . Number of bedroos .st�......Garbage Grinder ............ Lot Site .�1...4?..K .�t��••----•-• - y Water Supply: Public System and name ......................................................._...................................................Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Cloy Loom ❑ Hardpan ❑ Adobe ❑ FII( Material ............ If yes,type............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, ate must be placed on reverse side) NEW INSTALLATION: (No seplic tank or seepage pit permitted If public sewer is available within 200 feet.) 11J PACKAGE TREATMENT ( ) SEPTIC TANK I ) Site................................................ Liquid Depth ........ W Capacity .. ...... Typo .................... Material...................... No. Compartments ........ Distance to nearest, Well ....................................Foundation ...................... Prop. Line ............. / LEACHING LINE ( ] No. of Lines ... ................. length of each line .......................... Total Length ................_._. .... 'D' Box ... .. Type Filter Material ....................Depth Filter Material ...................................._.... Distance to nearest, Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT ( i Depth . Diameter ................ Number ............................ Rode Filled Yet ❑ No C Water Table Depth ................................................Rock Sire ................................ Cistance to nearest: Well ........................................Foundation .................... Prop. Line ........._... REPAIR/ADDITION(Prov. Sanitation Permit# ........ ................................... Dote ..................................) Septic Tank (Specify Requirements) ... ...................................................................._....................... ............._....... ... .. Disposal Field (Specify Requirements) .........is7.....'. ...:r?........ .!. .<Y'E.K.... .1- ......._ ....... ...._. .........................._....__. . ... ............... .............................. ................................. .................................................... .... . _..._............._.......................................... ......._ ... .......................... .__. (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done In accordance with San Joequ!n County Ordinances, Stale Laws, and Rules and Regulations of the San Joaquin Local Health DisMet. Herne owner of (ian- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, I shall net employ any person In such manner as to become subiect to Workman's Compensation laws of California." Signed .. ........................ Owner ✓.. . By _ ` 1- - 7it1e J t,4 \.r ilf other than owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY /._. i ,,,�..v-C- t�7_.... . . . .............................. DATE ....Z.-.3Z.-.....7. ............. _ BUILDING PERMIT ISSUED . _. _. .,......... . DATE __. .... .._ ._. ADDITIONAL COMMENTS .- - _ __ .. . .. .. ..... ............ 1 , _ / _.. .. .. .. . ..�-7 ) ... X7.7• Final Inspection by: :._.1' (..'(..>/l_c�.l�.. .... ..............6010 - SAN ale .SAN JOAQUIN LOCAL HEALTH DISTRICT EXHIBIT D I Of. 2 7/72 3 .1 E. N 13 241. 68 Rrv. 51.1