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FOR OFFICE USE: `APPLICATION FOR SANITATION P 1lT Permit No. 3Y-_71- . -------............ .._"- (Complete in Triplicate) po Date Issued ..._................................. " This Permit Expires 7 Year From Dare 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 with County Ordinance No. 549 and existing Rules and Regulations: 21PCENSUS TRACT JOB ADDRESS/LOCATION ... .Y- � *�^r - - -- - - - )�rt1�' 'G.- . _ . hone Owner's Name /L•�r.'2'?a+.^�'-"'1-------r l-------- -- :..GR.+c,bl---------------------------- -------- I P �d t1i -- '---. City ------ ----- Address . e2 J� a C' E r L - - hone .? Contractor's Name ..��t c±z/r j'.��-� a ' - ecP. <'4e License # t,4o '.(�.--t-.f U' Installation will serve: Residence ['Apartment House❑ Commercial []Trailer Court a Motel ❑Other ------------ ---- ---------------- C Number of living units:---/..... Number of bedrooms .....�+�-aGarbage Grinder ------------ Lot Size _. ux.l<a's4 L, ^-....------ Water Supply: Public System and name ------------------------------------------- _ Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam V Clay Loam ❑ Hardpan 81 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 seepage pit permitted iif/public sewer is available within 200 feet,) T 7 o L PACKAGE TREATMENT [ ] SEPTIC TANK] / Size.... .-. .-. U... _ S_. .._._--.----- Liquid Depth _.../.................. Capacity ..�.�L'0--- - TYPe !:-;L Material... d:y,.a:.� ` No. Compartments 4-------------- Distance to nearest: Well ....._ Q-- -------------_Foundation ...-..1..n----_.. Prop. Line LEACHING LINE [k] No. of Lines -- --- Length ofeach line..-sr0.--------------- Total Length ._- ................. " 'D' Box 4-io-.. Type Filter Material /2&.........Depth Filter Material .----1p..-_...................... Distance to nearest: Well -...v Q.._�.---- Foundation 1.0_--..-.__----- Property Line t....__..._....._.. SEEPAGE PIT Depth _c2...------ Diameter 3.3. ---- Number -------i—--------------Rock Filled Yes �t No Q Water Table Depth ---J iapp----------•-----------------'-.__Rock Size ........�'.• ................ Distance to nearest: Well 14".--.. --- .....Foundation ---/.A----....... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ........_------ -------------------------- Date _---------------------.----------) Septic Tank (Specify Requirements) ._--- --. ....... ............._------._..._.-.___..---_---- Disposal Field (Specify Requirements) ---------------------------------------------------- - ......... - ...... ------------- ----------------------- ----------------- -----------------_----------..................................... --------------_----- - ._. ._ (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 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 ---- Title ........-------- ............... .... (If other than owner) FOR DEPARTMENT USE ONLY / /�� ri_-Ge-9- --------------- --------------- DATE ----- -/----�,f APPLICATION ACCEPTED BY _.e'��` ....__-_.............. " ---"- BUILDINGPERMIT ISSUED --- - ------------I---------------- --------------' ---- ----------------------------...------DATE -----------_----- - --------- ADDITIONAL COMMENTS -- ------------ ----------------------------------------------------------------------------- -------.-......-----.....-------------------------------------- ...------- - ---------------- --------------- --------------------------------------------------------------------------------------------.....-----------------.--------'-------"-'-_-'----------- -- / - x � - -------------------Date Inspection by: - ---- ----' . .-.- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M