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~� CATION FOR SANITATION PERMI i A Permit No. (Complete in Triplicate) 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,w�th County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _. 45 ..CENSUS TRACT Owner's Name 77-E.A K.�- "' •- Phone ------ - - - :," m' - Address ---- 1 = f` --- _IF- r - t,v„(i City -- debt ---------- - ------- ---------------------•----- S:. / Contractor's Name ----- a l d t,_ ! AI.License # IpJ?o? - Phone --------------- -------------- Installation will serve: Residence Apartment House-❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ------------------ ---- - - --- -------- Number of living units: . _ Number of bedrooms .._3____Garbage Grinder Lot Size ____.C�'d�"Z'`f Water Supply: Public lystem and name _.. -- -------------------- -- - ------------- -•----------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam lvl/ 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 see age pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size.6.n---L0--- - ..... . Liquid Depth -4.__?................ Q� Capacity 4 Type MaterialNo. Compartments --_ . Distance to nearest: ,Well __---.-.Foundation ---f,O Prop. Line ................ LEACHING LINE [� No. of Lines . _--. _ ----- .._ Length of each line.----?�%_`-------- .------ Total Length --- .Y.U............... 'D' Box ._�-. -... Tya Filter Material __% c(S_._._-_Depth Filter Material ._. .._1 .................... ........... Distance to nearest: Well . _ ------ Foundation /P Property Line ----- ................ SEEPAGE PIT [ J Depth -_---_---- ____- Diameter __ _ ___________ Number .- _.___ Rock Filled Yes ❑ No C Water Table Depth -- .------------ -----------------------Rock Size ------- Distance -.. . - --- -Distance to nearest: Well - .-__--_-_-______________----------Foundation ___ __ . . .- _ Prop. Line ...._......... REPAIR/ADDITION(Prev. Sanitation Permit# ---------_.----------- __---_-------------- Date __-_ - -----_ -----_---) Septic Tank (Specify Requirements) - ----------------- ------------- ......--l- - - ....... Disposal Field (SpElcify Requirements) ---------------------------•----------------------------- ------------- --_ ------------ -- -- -----------------------------------------------------•---------------•------ ------ ------ (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 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _ -------- __ Owner By - - ------------------ -- I'- -If 4. n ` `•---- Title - (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - - - -------------------------------------------------- DATE - L 2`+7 BUILDINGPERMIT ISSUED ------- -----------------------------------•--------- •------------------------------•-•-- ............--DATE -----_-----_- -------------------- ADDITIONAL COMMENTS ----------•--------•--•---- - ------ ............... ..................... -----------------•---- -------------------------------------- •--•----•-•-...._--•--•-------•-•-••-•--•------•---••-----•--•--....----_..._.._..._.•--•- ----•------• ---------------••--•---•--------•--------•----•----•-•-•------------•--------------------- ------•--------------•---._. -- Final Inspection by: - - :. ;--•--- -•---•-•--•------•---•---... -------------------- ---- ..Date 1--.fir '7{ SAN dOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M