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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- (Completerin Triplicate) Permit No. 72 .3.o...� �! This Permit Expires 1 Year From Date Issued Date Issued 3.-..2 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application its made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCA�T/I{ON ` /6 6/ �. l..W.f... _ .. .�..1.Y.�. ._ L- /�l./.........CENSUS TRACT ...........................7 Owner's Name . ./ "r P—, /... !-`�.1.ft.� .plN �, - Fel.. --.-- .. . Phone'.7/_31,7_3..r-5..-/ Address 4G (_ /. V_t..^._l�.l-.P_�.N ..... -- ----------- City .. ....C,4,--------------------- Contractor's Name .._� . .z4..r"ITI! S}�._. . S-Q.�S. ...I. N�..License # I GCS.r'-1 -- Phone 4�7.C�3_5. ._L.. Installation will serve: Residence (Apartment House❑ Commercial ❑Trailer Court ❑ Motel p Other .. -- -------------------- d Number of living units: C�_.).. Number of bedrooms .......Garbage Grinder ._..___ ---- Lot Size .ACkEAGE........... Water Supply: Public System and name ------ - .......................................................................................Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material . If yes, type __............. _. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION- (No septic tanit or seepage pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ ] SEPTIC T4NK [ J Size...- ............................... _ . . . Liquid Depth ............_............ Capacity -------- ---- - -- Type ----------- -------- Material.. ..._-- - ----- No. Compartments (� Distance to nearest: Well . ------ _... ----------------.....Foundation .-___.....- ... Prop. Line ..........6........... LEACHING LINE [ I No. of Lines . ._. _ - Length of each line .. . ... .. ... Total Length 'D' Box Type Filter Material ....................Depth Filter Material ...._............_...._.............. Distance to nearest: Well ............ Foundation -------------_-_...... Property Line ------_._......._.....__ SEEPAGE PIT Depth -------- Diameter ---------- ..... Numbe• ........................... Rock Filled Yes ❑ No Q Water Tabs Depth ------..Rock Size ................................ Distance to nearest: Well _. .....................Foundation .................... Prop. Line .__ ................. REPAIR/ADDITION(Prev. Sanitation Permit# ..... .. Date ..................................) Septic Tank (Specify Requirements) ------------- .._...---- --- ----------------•-•---------•-----••----•-----•-----.............----------.._...----------- I Disposal Field (Specify Requirements) ..A.D--D.r..taDN�AL,... / .3.f�.......�e.A.C.H..__-. R.A.I-N................ . .. ... .... .. .... ... ..... . - .._ . ------...................................... .__.....------------. ......._.............. . _.. ..................... .. . ........ .. -------........................ .... ... . ._. - (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 Rules 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 beta su ject to Wor an'somptrpatioon�la�w!s of California." Sign �:. .-.... - SS U Y,_L - ------ - . . Owner BY (� -�(.r-C..�i�- .. . �� L - Title ..� . �...... ... (If other than owner) ------ - -- — PARTMENT USE ONLY APPLICATION ACCEPTED BY ---- - - -- --------------- .......................... DATE .. .--1. 7"-----•--------- BUILDING PERMIT ISSUED -------- . -- .... . - ------- ...........................................................DATE ......................... --•------...-.. ADDITIONALCOMMENTS ----- • ... . .. .....................-_...................................---. ...........---...•..._.:._....._••--..........._.. -----------------------•----- -----------------......-----•-•------......_...----•---------............_............................--...._.._.......... _... ,../._.......--------------------------------- ..........._..............-- •------- a-- Y Final Inspection by. .. .. .r.:: ...............Date -----__PO.. SAN JOAQUIN LOCAL HEALTH DISTRICT LE. . 9 1-'68 Rev. 5M