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' r FOR OFFICE USE! APPLICATION FOR SANITATION PERMIT L Permit Na. (Complete in Triplicate) - - - Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein j described. This application is made in compliance w:tli County Ordinance No. 549 and existing Rules and Regulations: 10B ADDRESS/LOCATION �J%X71 g �;'4 - t " �� T"�� .. CENSUS TRACT Owner's Name 1t. 0-'r- �,Cr _.. .... . _.. .. ... ....Phone .. __.. Address �y . 044-', Corsa�d ... City ..._ _...._ Contractor's Name .s cJ. .J / .. O2s Litems tR I W3.'7'_. phone . Installation will serve: Residence[Apartment House❑ Commercial ❑Troller Court LJ �, Motel ❑Other Number of living units: Number of bedrooms ._X.-..Garbage Grinder . ___. .. Lot Size .. ^ `"'J-- !r . Water Supply: Public System and name ........ ............... .............. ........ I.......................... ivcfe Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay F) peat❑ Sandy Loom [3 Clay Cloy ❑ Hardpan❑ Adobe bo 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 [ I SEPTIC TANK( j Size.. .................... . Liquid Depth ... ............... Capacity11 Type ... 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 .. ....... Y� Distance to nearest: Well ........ foundation Property Lin° SEEPAGE PIT [ ) Depth __. Diameter . .......... Numbe' Rock Filled Yes ❑ No Q Water Table Depth .... ._.._.. .... .Rock Size __...... _._..... r Distance to nearest: Well ... __.._ ....................Foundation _.._ _ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit sF• ....... .. Date ...... -- - ) 1 Septic Tank (Specify Requirements) - -' - -- - - Disposal Field (Specify Requirements) - - - - - - �; ,. . ...... uL,Ca -U. Sc 2r r (Draw existing and required addition an reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Jeeel"I" County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner or Ilcea- sed agents signature certifies the following: person in such maturer 4 "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any M as to become subject to Workman's Compensation laws of California." /� Signed / .� ... - .._ .. Owner g /.�'- l-'.�'j�" •:: . title 'e/ic.(c...._6e'v . Y then than . (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �� ' -<� - - - ._.- DATE 6 ' I'Y-6-'� BUILDING PERMIT ISSUED DATE - ADDITIONAL COMMENTS / _. Date 6 Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M