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FOIL OFFICE USE. R APPLICATION EOR SANITATION PERMIT T 4 [Complete in Triplicate! Permit No. .. 5....-----_ __... . Thie?ormit Expires 1 Year From Date Issued Date Issued'. Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations. _ • JOB ADDRESS/LOCATIO ...... --- ....CENSUS TRACT ....... ... . . Owner's Name ' ...Phone -.. ....... ...74L....... Address ' ------ City ..... .............. Contractor's Name .._.---•-----•-___-- - _-• `__,•So� •____..License#,r s.`f`�4�. . Phone 1�6 ... ... .... _ �{{ = Installation will serve! ResidenceApartment House 13 Commercial oTroller Court 0 t Mote ❑Other. Number of living units:_..__. _.-:- Number of bedrooms ..I_....:Garbage Grinder Lot Size r ; a� �r-� ................... Water Supply: Public System and name ----...-•---•...... ........:...E.. Private ................. TCharacter of soil to.a eptl_of 3-feet:-_Sand —Silt 0 Cloy, ❑.-Pea!❑ S ndy Loam_0—Cloy_Loam-0,,,,..-. . Hardpan❑ Adobe Q Fill Materia! ............ If yes,type................ ........••-- (Plot plan, showing-size-of"lot;-locotion•-of-system-ln-relation to wells, buildings, etc, must be' placed on reverse side.) NEW INSTALLATION: (No septic to'nk or seepage pit permitted if public sewer Is available within 240 Wfeet,[ PACKAGE TREATMENT [ ] SEPTIC TANK f ] iae._...-.. �. .�..±---------------•---_---- Liquid Depth S �........---oQ Capacity 1It - . Type - Material -:. No --- - --••--•.-- oCompartments 1 ,,k r Distance ao nearest: Well .---..... ,0................Foundation /.0... ... Prop. Line . �........A t .� ► 7- - LEACHING LINE No. of Lines `#.� �ngth of each line- � .:........... Total Length ...1Q................... •D' Box 4f T Filter Material"— Type i ..,.Depth Filter.lMaterial ..... l.s�..................... •-•-•-- Distance to nearest: Well ... �...t`......__ Foundatio _.i_.� _=..7.. Property Line ._ .:'� ....... SEEPAGE �`, Q Depth .._. ........ Diameter r, r.................... Rock filled Yes No ::.;,Number ,( -- Distance to nearest. Well _..._._� Size Water Table Depth ........... -• --•----_ • ' =-----...............Rack - � ,.Foundation Prop Line .... � REPAIR/ADDITION(Frau. Sanitation Permit ` ............ ................................. Dated Septic Tank ISpecify,Requiremenfs`,, ... # -..-------------------------•----.....---•----- w. Disposal Field (Specify Requireme#sI • ............... --------•----- l _. ....................-•---•-•-•-•............... . ................... (Draw existing and,required addition o verseisic!6)1 #. !"hereby certify that ! 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 Locat Health:District. Home owner or Ikon sed agents signature certifies the following: I I "l certify that in the performance of the world for which this permit is issuedd,:i shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." ti. a r.t. •' ` f {Signed --------- -••=--....-- � - _._..----•--••-----------••---•----••---- Owner B -----• - -•--- • --- 3`` ' Y , Title _ h ' ... .............�. .�_._.'.^. (# of than owner[ ......... FOR DEPARTMENT USE ONLY -------------- !APPLICATION' ACCEPTED ACCEPTED BY _._.._-e-10— [BUILDING .-_--_- -- DATE ., _.G3_...7. r- • ---.................•--.... ._ 1 BUILDING PERMIT ISSUED -----•----•------...._ ------•-•- DAT E - ADDITIONAL COMMENTS ................_...__- ---------------------------------- --------------.-.. ------ Final Inspection b - P Y- -•----•----- ---- -'- --'•.............................................................__...------••--•-•--•----._Date .....11-'-� `� --�'�.-------•----... EH 13 2h 1.68 Rev. � SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71 3H C