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FOR OFFICE USE. APPLICATION l"'OR"SANITATION PERMIT Permit No. .7j-Sz7 (Complete in Triplicate? z; Y,. •`�� This Permit Expires 1 Year From Date Issued Date Issued .S`.7..7:3 ...._.. 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....CENSUS TRACT . ................... Owner's Name . .. . . }' _�� -... �. eca..11xt.Q1 .Phone ../ " Address . ...... i 1 ...... ----------------•--•-----------........._..._. City ._.....- '...................... .. Contractor's Name .... ............... ...................License # .-. .� , t. Phone Installation will serve: Residence (Apartment House 0 Commercial❑Trailer Court 0� Motel ❑Other ---------------------•••----...-- # 11 Number of living units:..` I,..:..Number of bedrooms _... Garb t age Grinder Lot Size a. Water Supply: Public System and naind ........................ .__................... -_------ -- "--,'Private ❑ ..--r- i . ------------- Character of soil to a depth of 3 feet: * }Sand❑ Silt❑ Clay ❑ Peat(3 Sandy Loam C) Clay L am ❑i Hardpan E) Adobe Xf Fill Material ...---...... If yes, type --.-----------------........ b - -- A (Piot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.] NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewerls available within 200 feet,) -_ PACKAGE TREATMENT SEPTIC TANK- ] �Siie............ -----------• ---__-•- - ---. Liquid Depth ................. .._._._..---• - ,. -- i . .. Capacity ---- Type ...............:..:-: Material.--.-...-.�_-.---••--- No. Compartments ................. � i, 1 Distance to nearest- Well ................ ........Found'tion ...................... Prop. Line ................. LEACHING LINE No. of Lines - .-..- - Total Length .-.. ._Q._� Length of each line g .� , .....-•-----, Z i 'D' Box l Type Filter Material - Depth Filter Material ,.� Distance to nearest: Well -------- Foundation ---- Property Line ._., C ...... v.•� SE PAGE PIT D(j Depth ------ -:-Diameter.:�e� � dumber_„�.�, -..;1...-_.....__ Rock Filled Yes ] No [�� \— Water Ta'bi `Depth ' ` "i $,Tt I ----.......: -------------------Rock Size ------..�.--- A Distance to nearest: Well `- .Foundations...._ Prop. Line , i . = ...------ --- --••� -•-•--.. + 1 REPAIR/ADDITION(Prev. Sanitation Permit I# ........................................ .. Date ...................... � 'Disposal- Septic Tank (Specify RequirementsJ� --- ------ -----------------------•------------• ____ Field•, _ ................•----...- �W `. (Draw ex!stin and required addition on reverse side} I hereby certify that°l 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 Keen- set(' 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." I ., Signe l i �•y� -- caner BetC �, - ----- ---------------------•- Title ...... (If'other''th'n owner)- - - .......................F . DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . .. DATE ... BUILDING PERMIT ISSUED ..... .. . ! ... ., 7- --------------•-----....-..........----._..........------------DATE ............... ADDITIONAL COMMENTS .. . ' . . ..........---7......:... ..... - Z. 4 ------------------------- �: Z. ..v------� .......------•........._........---------......... .._................-•..............................................•------ ................. ....-•......................... Final Ins ection b --------------------•---•---••---...... .._ �. P Y ............... �.-......-.... Date :.:...... .............. N, % SA N,.JOAQUIN-__LOCAL�H EALTW_DIST'RICT ».. _...,.._t_ -_ E. H.13 ,24 1'.'68 Rev. 5M �' �' '� 7/77 3 w