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f FOR OFFICE USE: �1 ATION 'FOR SANITATION PERM,IT --------------------- -------------------- Permit No: .j�� (Complete in Triplicate) t 14`{ ----------- ------------------------------------ - Date Issued q✓ - --------------------------------_----------------- This Permit Expires i Year From Date Issued _q- - -- 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA, N �� "'� �1{ 112 ------------------------CENSUS TRACT - i Owner's Name --- -- Y � .------------------------- Phone --- f Address _ d - �- - 0- - _Q_----------------• •--- City --------------------- --------------- I ; Contractor's Name ----------- ------------ '------------------------------------ --- ------License # ------- ----------------- Phone ------------------------------ Installation will serve: - Residence ❑Apartment House❑ Commercial : Trailer Court ;❑ ►� .. Motel [] Other.-- Number of living units:----------- Number of bedrooms _- /_----Garbage Grinder__ Lot Size _4�4__k----9S.------.- Water Supply: Public System and name-_01-------I ___ ,----- ------_ -----------------------------Private ❑ Character of soil to a depth of e ✓ Sgnd'❑ t❑ Clay ❑ Peat❑ Sandy Loam Clay Loam Hard} pan ❑ Adobe ❑ Fill Material ------------ If yes, type ---_-------_________ r' .(Plot plan, showing size-of lot, aocatian 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,) PACKAGE TREATMENT[ 7 SEPTIC TANK'[ Size_S6____ - -Q'------- --- --------- Liquid Depth - -------- __----.___-- Capacity /Ik-0_0-,-- Type -------- Material_-�'2'..�. Io. Compartments ------•..-_-- _ Distance to nearest: Well _� -----------------Foundation ---------- Prop. Line ---*45. .......... LEACHING LINE [ ) Nod of Lines --------- _-_______ Length of each line____ _ --- Total Length .............. `b' Boxy/(,)fl,, Type Filter Material�� 44th Filter Material ---70-IC&_--_ ----------------•-- Distance to nearest: Well IS&70--------- Foundation ---/0-/ Property Line --_.S_�_, _ y SEEPAGE PIT [ ] Depth Diameter ---------------- Number ----------- ----- Rock Filled Yes ❑ No i(] Water Table Deptli -------------------------------------- -------Rock Size - ---------------------+-------- f � Distance to nearest: Well ________________________________________Foundation ------------------- Prop. Line ---------------------- REPAIR/ADDITION __-..-___--_-----REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------- Date ---------------_ Septic Tank (Specify Requirements) __________________________._-- - __ Disposal Field (Specify Requirements)" _ _�_—:_1--------------•- ` ---------------- --------------------------------- i (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 bec a subject to Workman's Compensation laws of.California'. Signed , e - �= '^" ----------------------------- Owner By ------------ ------------------- ---------------- (if = Title - ----------------------------- ---- --------------- -- ----------------- other than owner) - - --- FOR .DEP TMENT USE ONLY APPLICATION�ACCEP�TEDY � -- - -----`-.. DATE------ BUILDING PER -� DATE -------------------------- ------------------------------ ---------- ADDITIONAL COMMENTS 1 . .14_. Vzc `eh� --------------------------------------- ------ I ----------- --------------------------------------------`--------------- -------------------------------------------------------------------------------------------------------------- -- - - ----------------------------------------------------------------- --------- ina Inspection by: -------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E H, 9 1•'68 Rev. 5M,