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APPLICATION - FOR SANITATION PERMIT . ------ 7k--, �a ICornpleteIn Triplicate) Permit No, `-__...- . This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin local Health District for a permit to const th ork herein described. This applied#io`s� is made in cornpliahcs.with County Ordinance No. 549 and existing u es and Mations: JOB ADDRESS/LOCATION .._./ " CENSUS Owner's Name =...•`.`�.'-t:........ �j `.........Phone Address �,� f�1... ?,21r !''/-[-•ams �'�t�-� 7. --- ------------- City.. ......_....-.. -...... .....-....... . - Contractor's Name :--- ------------- - `�-c- �_.:-..... --....License #' .71 �' ... Phone d Installation will serve: 1; Residence"Ap rtment House Commercial oTrailer Court 0 Motel ❑Other ........................ Number of living units:.--V•... Number of bedrooms ..0------Garbage Grinder ............. Lot Size . C � Water Supply:-Public System and name ............. . .......................................................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [j Peat[3 Sandy Loam Clay Loam'o Hardpan Q Adobe 0 Fill Material ............ If yes,type ° (Plot plan, showing size o f lot, locationof system in relation to wells, buildings, etc. must be placed on reverse s(de.1�3 NEW INSTALLATION: (No septic tank or seepage page pit permitted if public sewer is available within 20(} feet,j Q PACKAGE TREATMENT ( ] SEPTIC TANK ...._... Liquid Depth ............... W ` � ] Size------------------••-•-------•--•--- I,., Ca�pacitY --------•----------- Type --------_-•------- Material---- ---. _--------- No. Compartments ...................... � Distance.to nearest: Well -----------......................... ,. Foundation ...................... Prop. Line ........-.............. LEACHING LINE [ ] No. of Lines ------------------------ Length of each .,line-------------...•...... Total Length ............................ Box ............. Type Filter Material ....................Depth Filter Material ....................... Distance to nearest: Well ------------------------ Foundation --- Property Line ...................... SEEPAGE AIT1p [ ] De th ----- --- -----•---- Diameter --------------.. -Number _.............._.....- : -. Rock Filled Yes ❑ No Water Table Depth •--------------- ..........:....-------•..:.:.-.Rack Size ...--•••--•---•.....- Distance to nearest: Well --------------------- -__._..Foundation .--................ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation. Permit# ._.......--..--------.-- .............. Date .................... Septic Tank (Specify Requirements) -------------- -- -••---...... ` ........ Disposal Field (5pecif�y�ARquitem ents) -- -�'? '- `�- 7�---..------•------ •----•-•----------- --• - --------- --- ----------------- ----------------------- Lq I! (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State laws, and Ryles and Regulations of the San Joaquin Local Heallh.District. Hayne owner or licen- sed agents signature certifies the following: "I certify that in the perfoneance of the work for"which this permit is issued, 1 shall not employ any person In such manner M man• Com ensation laws of California." S's ned ec. a uh er# to � g ----- Owner x BY'= ------ - - -^14 ' If other than Title . _.. ( owner] �p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 7 ................ DATE .......:.- BUIf_DING PERMIT ISSUEDI------------------ DATE ....... ................ADDITIONAL COMMENTS �ee ! - ---------------- •- --- ------- --- - ------------- ---------- final Inspection 13 24 1-6 68 Herta ---------C3ate -�-.�.- r1 --------- ------------------_..... ----- �� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M i