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+ FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .75. -. This Permit Expires ] Year From Date Issued Date Issued ....3--3..7 ;5 t 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 C u / p o my Ordinance No: 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �...... elL!5----- CENCT Owner's Name ..... ..R.. /�. •�S rR....... Phone. Address ...... .P.._.....-T. I-.. � City ... .............. ...... Contractor's Name ...._A, Z......uG.446C ... "-•- ..:.---...License #�.�5:��.... Phone Installation will serve: Residence [J Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other ............... ..:..: ...:..... :...... .. Number of living units:... ........ Number of bedrooms ... ._.Garbage Grinder .._....--_... Lot Size .....+�Q•--�— Water Supply: Public System and name -- "---'- ...............Private Character of soil to a depth of 3 feet: Sand ❑ Silt E] clay [3 Peat F1 -Sandy Loam Clay Loam ❑ ... . . , F w Hardpan ❑ Ai4obe'jT Fill Material .----.-- -- If yes,type .... ........................ (Plot pian, 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 if public sewer is available within 200 feet,) TREATMENT [ ] SEPTIC TANK ------------ ----------- Liquid Depth .......... ........ PACKAGE Size-------------'_.-_. �� 1, .._.. Capacity _. ... ......___'TYPb-..........--•--._.. Material............. ....... No. Compartments — �'Distonce to nearest: Weil , Foundation ...._............ Prop. Line ................... ..� LEACHING LINE [ ) No. of Lines ... �L'6ngth of each line...:.... Total Length .._. ... 'D' Box .._._ Type Filter Material }.';.' ..---------Depth-filter Material . Distance to nearest: Well _.._'.�:_:. _ ,-- Fo ndotion Property Line ....- ..... SEEPAGE 'PIT [ ] Depth --# '`- - - '••--•---��- ---.._ Diameter ---- Number -------_-- ...... Rock-Filled Yes ❑ No Water Table,Depth __.-.-.--------- ....... .._..Rock Size ........-................... C i Distance to nearest: Well ,.--.'-•-----------_•-'----------------Foundation _...------- Prop. Line ........__....-----..Vt REPAIR/ADDITION(Prev. Sanitation Permit# ------------- _............_...... Date .............. ) Septic Tank (Specify Requirements} ._- ....� t -.---A,4 7 �u ....--•-- --•. ............................. •-----.--- Disposal Field (Specify Requirements) ------ `f? / r '----'--'- ........-- •'----... --'-' ... ..... (Dra'w 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 lows Jand Rulesand 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 or a 's_Corn eniatioh,laws of California." t - '. Signed .................', .............� _.rt . Owner ` '- . Title . ... . . ......... ... I (If other thanowner} •-�.� �g� DEPARTMENT USE ONLY APPLICATfON ACCEPTED�,$Y ....- . ......'-- --- DATE . . .. a '-- .... . BUILDING PERMIT ISSUED'-- -_.. .... .- . ..... .........:..._.................:. ................................. . y .�....... 4 - (i Zt _ y- ..D..A...T.E .�-.3.._..-..ADDITIONAL COMMENTS------------------------_ Y ------• ---------•...... . ............... ................=�. -•:--.-.-_.:. --1•--•.-.-.•.•..'. . ....... .. -------------- ........................b ............... _ . Final Inspection y: .. . date .�. SAN JOAQUIN�LOCAL..HEALTH;DISTRICT E. H. 13 24 1-'68 Rev. 5M