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City <br />Water Table Depth F.0 Rock Size It jr 14 / n <br />t f Distance to nearest: Well _1 4 Foundation 10' Prop. Line 4' , 1 <br />L REPAIR/ADDITION (Prev)Sanitation Permit # Date ) <br />d <br />Septic Tank (Specify Rrquirements) <br />Disposal Field (Specify Requirements) <br />Motel 0 Other <br />Number of living units. / Number of bedrooms -Garbage Grinder'5 Lot Size / <br />Water Supply: Public System and name <br /> Private El <br />Character of soil to a depth of 3 feet: Sand TJ Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loam -0 <br />Hardpan 0 Adobe 0 Fill Material If yes, type <br />be placed on reverse side.) Ii‘) <br />Compartments <br />Line . <br />/PI) <br />(Plot plan, showing sizel of lot, location of system in relation to wells, buildings, etc. must <br />NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) i <br />PACKAGE TREATMENT [r ] SEPTIC TANK,* Size .vt . in <br />apacity /2- 1171 Type ee144k4 Materia1.60/4.6 No. <br />Distance to nearest: Well crt, Foundation AP Prop d <br />I/4-6 LEACHING LINE Al No. of Lines gt" Length of each line Total Length <br />'i 140.- T teil 12-if. De pth Fill-Material IF II <br />Distance to nearest: Well .3-61 i Foundation Property Line <br /> Filter Mara D' Box Type <br />Ili SEEPAGE PIT Number Rock Filled Yes Al No 0 ii <br />Oepth Diameter a 3 <br />Liquid Depth <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />FOR OFFICE USE: <br />Permit No. 74f) <br />Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br />and existing Rules and Regulations: described. This applicatioh is made in compliance with CountyI dinance <br />11 ‘ <br />JOB ADDRESS/LATIO ' / e) -- <br />Owner's Name 0, . r. A if i i, <br />Address ../. /404 --- <br />Contractor's Name 1 License # Phone <br />Installation will serve: Residence 0 Apartrnent'House 0 Commercial OTrailer Court 0 <br /> CENSUS TRACT <br /> Pho e <br />r - <br />I <br />II <br />(Draw existing and rec(uired 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 agents signature certifies the following: t <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 sul,slect to Workman's Compensation laws of California." <br />Signed . ‘0.7. 7, .44_, Owner <br />By Title <br />(If other th`an owner) <br />1 FOR DEPARTMENT USE ONLY _ _ <br />APPLICATION ACCEPTEb BY DATE 1- il —7 0 <br />BUILDING PERMIT mug) DATE <br />ADDITIONAL COMMENTS 11 <br /> <br /> Date FIE9 I2ro <br /> <br />Final Inspection by: <br /> <br />111 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E.H. 9 1-'68 Rev: