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FOR: OFFICE USE: APPLICATION FOR SANITATION 4 PERMIT _....... Permit No. .-. 'r......_... (Complete in Triplicates ....... Date lisued .�_,7.-.75 ............... ................ .... this Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per mit,to construe! and Install the work herein described. This application'.Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: wT.z�c l�.iAt�10ENSUS TRAGI JOB ADDRESS/LOCATION ..Q�.... .... 4,.....:! ..:.. �7...... tJ/ .......................... Owner's Name .. '` -��.� ''i.....:- �..CR..-.1:T....1.. ......... ........:................Phone ..., Address ..... ...........city -. ..1.. . 14 asp?..........1 1...1..1: Contractor's Name r 'r �_ �---...-----•..--•-----••--•---•.................. .y License # -...... .......... Phone . "'..................... Installation will serve: Residence Q Apartment House t] 06mmerclal❑Traller Court Motel ❑Other... 10.'r.?/. ...1:}:l4 C i3 Number of living units:_-..�•�•– Number of bedrooms .......Garbage Grinder ............ Lot Size ....:.�...�,.�...��,.............� Water Supply: Public System and name ............. _f5LA?....... ................................................Private,}' Character of soil to a depth of 3 feet: Sand❑ silt❑ Ciay ❑ cpeat❑ Sandy Loam {3] Clay Loam�' Hardpan j] Adobe❑ Fill Material ............if ye$,:type............... .....I...... (Plot plan, showing size of lot; location of:systemxin 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,l PACKAGE TREATMENT [ ] SEPTIC TANK Size................................................ liquid Depth ..._..................... Capacity )_2U Type Cr�Material...................... No. Compartments Distance to nearest: Well �PGtr3----....Foundation Prop. Line ......................0 LEACHIidG .. Total Length a (r LINE No. of Lines `..........f ...... ..... Length of each line.. ............. g Box ..O. Type Filter-Material --------------------Depth Filter Material ............................................M _ Distance to nearest; Well ----.. ...... _... Foundation ........................ Property Line ........................� -SEEPAGE PIT { l Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No Water Table Depth ................................................Rock Size -__._.--___•_-- _--_..--- Distance to nearest: Well ..............foundation F...................... Prop. Line 4EPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ..................................1 1 Septic Tank (Specify Requirementsl ------- -•------ ---•----------•--•--•-----••--•- -------------------- g DisposatField )Specify Requirements) ------------------------------------------------.....................................................................1............... ----•••--------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 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 beer*orna subject to Workr!7nCompensation aws.-I California." Signed 1------- ------- - ------- --------- ------------ Owner BY -Title --------------------• -----------------------••. • ......-. (I# other than owner) a FOR E TM T USE ONLY APPLICATION. ACCEPTED B ----.. DATE .. 3r BUILDING PERMIT ISSUED --------------------------------- ................................ .---..--..........--•---........DATE ....... .................. ADDITIONALCOMMENTS ..-----•-------•-_ . .. .................................... .........................................I...... .. --------------------------------• ------ ----•--• ----• ------------•------ .....,-........- -------- ......................... ...--•--•-•-••---•-.--------•- - ..... .... ... ...................... ...._..---... - Final Inspection by: .............._-- Date ... .. � ,- . ... EH 13 24 1-68 Rev. SAN J � N LOCAL EALTN DISTRICT $�7 3M