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1 <br />Number of living units- / <br />Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />JOB ADDRESS/LO de-e--,--ev CENSUS TRACT S ) <br />_ <br />Owner's Nam- Phone <br />Address <br />Contractor's Name <br />Installation will serve: Residence Apartment House 0 Commercial 0Trailer Court 0 <br />Motel 0 Other r — <br />Number of bedrooms, .5 Garbage Grinder Lot Size <br />Water Supply: Public System and name Private <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam 0 <br />Hardpan 0 Adobe 0 Fill MOterial If yes, type <br />ION 627 '3 g2-42 77 <br /> City <br /> License # Z.' Phone <br /> <br />FOR OFFICE USE: <br /> <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />Permit No. - <br />Dote issued /0 --/5' 7-3 <br /> <br />(Plot plan, showing size of lot, locatien of_systern In relation to wells, buildings, etc. must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seepage' pit permitted if public sewer is available within 200 feet). )4*) . , , •/ <br />PACKAGE TREATMENT r ] SEPTIC TANK 17) . . Size te/P Cts 1-4` /-t* 4; / Liquid Depth 'I V/ <br />Capacity P-OPe re Type --..} Material 0-1A---c-- No. Compartments 3 <br />i Distance to nearest: Well , i ' -5,p- Foundation _la. k Prop. Line. . - _ b. .... <br />LEACHING LINE if '- No.. of Lines . 3 ' • Length Of each-lini • 5'12/-1"--- Total Length ../-54 <br />'D'' Box .,._/.. . - Type . Filter Material '5./R, Depth ' Filter Material • /9" - * • .. <br />Distance to nearest: Well 3-0 Foundation /0/-/- - Property Line- , 5 <br />SEEPAGE PIT Pr Depth .... /-it:,. Diameter ! ..'/' .. Number . ..5 - Rock Filled •Yes pl No C) ..ACI <br />, <br />1'D <br />Water Table Depth • ..120._ Rock Size t4 '/3 '... P <br />Distance to nearest: Well ....... ./g.P. . Foundation / Prop. Line - ..../11.' <br />. , '7 <br />.. oe,' <br />REPAIR/ADDITION (Prey. Sanitation Permit # • - Date" <br />Septic Tank , (Specify Requirements) - • - :,---- • *- <br />! 1, . ,I, ,•-• . _ <br />Disposal Field (Specify Requirements) <br />• <br />(Draw existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and that the work , will be done in accOrdance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br />sed csgents signattue certifies the following: ' <br />Signed <br />By Ite41-7-P <br />(If other than owner) <br /> Owner <br /> Title <br /> <br />FOR DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY.... DATE .1 -•1/0 7-7 <br />BUILDING PERMIT ISSUED DATE <br />ADDITIONAL COMMENTS <br />" <br />_ <br />"I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to become subject to Work Ws Compensation laws of California." <br /> DatedrO -7/0 " Final Inspection by: <br />24 I -'68 Rev. 5M <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />7/72 3 14