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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................................................... Permit No. )Complete In Triplicate) . ". . --- This Permit Expires l YeFrom Dale issued Dote issued . :X7... ar - 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 mode in compliance ith County Ordinance No. 549 and existing Rules and Regulations: JOS AbDRESS/LOCATI P7.75.0 /L "'Y � ° .........._.CENSUS TRACT _--------•----•-------- Owner's Name ,...__- - .................Phone ....._.......... ...._.._......... Address7. .. - �—. ._jf .... - City • '- ......................._._._........»... Contractor's No ---- ................... -- ................ ------------- Installation will serve: ResideeoA }Apartment House C] Commercial OTrailer Court E] } Motel C7 other.. Number of living units:-.-..... Number of bedrooms ._,_:.Garbage Grinder ............ tot Size ..4 ----- ' ---------- Water ---- ;- Water Supply: Public System and name ________________•...M.........------ _.....__.__.......-•_................................__!_.:PrlvaM 5 Character of sail to a depth of 3 feet% Sand❑ Silt 13 Clay Q Peat Q Sandy Loom}Clay Loa A D }Hardpan Q Adobe 0 Fill Material............if yes,type............... .........:1 NN (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on to" side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ 3 SEPTIC TANK I } Size......................-........................ Liquid Depth _..........._.... ... Capacity ......... ... 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 ............................................ Distance to nearest: Well ........................ Foundation ......_._..._ .......... Property Line ....................... SEEPAGE PIT [ } Depth ------•------------- Diameter ........-...... Number ..........._---------------- Rode Filled Yes Q No (:3 ` Water Table Depth •_•_--...__.._....................------Jtock Size ......-........................ Distance to nearest. Well Prop. Line ........._........... C REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ----__-.__.____-__---___------1 6 Septic Tank (Specify Requirements) .................................-.........------....-•-------......._.^...._....................... -- _--- ----......._._.__. -------- Dosal Field (Specify Requirements) �,�.�._ -----•--___. `-._. ...-.----.......................... J�., tQ......-�-a¢ - mak --�------�- ! ._... . 4. - - ... ...._... • ••... .... .............••••-----•....._.........•--....._ } (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared .this application and that the work will be done In accordance with San Joaquin 9 County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health-District. Nome 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 net employ any person M such manner as to become subject to Workman's Compensation laws of California." Signed ................._...---------....-- - Owner By................................ - ------------- �..- - • _ .Title . .:. ........................ _._.... (If.other than owner) FOR DEPARTMENT USE ONLY __ __. ........... DATE ...c3"�? J� APPLICATION ACCEPTED 8Y -. •---------------------••--•-•---•--••......•. BUILDINGPERMIT ISSUED ....................-......---------------------_-_- ._..__- - - -- .....................DATE .......--------.__.._..... ................ ADDITIONALC0MMENTS ...................................................----•-...--_-_..-•----•------•---............................................................•---........ .--•-------.......................•-......_------.._.----••.........---...------....---•------....•...............................-•----•-•••••--•----•-•--..._...._.._._..............._ ----------•--------------- ---•-.---.--------..------.-.-.-_-.---.-.--.--.--......--------..-..-.-----•-••--_-----------------•-- Final Inspection by. ._._...W EH 13 2h 1-68 ib--v. _c44 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M