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FOR OFFICE USE: APPLICATION FOR SANITATION PRRmIT ...................Y._................................... (Connpleh in?ripllcate! Permit No. .... ......":�1... ......................................................... This Permit Expires t Year from Date Issued Date Issued .../`../.3: 7i Application is hereby made to the Son 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/LOWiXf Gi.77Z. ; Q ..q.;r"- .... ...................CENSUS TRACT ....Owner's Name ------ --------- :. _. . = f hone _ _ .. --- P6- AD3 Address ---------- f._.. ity . --- --- •...---•........_ .....C Contractor's Name ............ .�.�? - --o-7ir4 _.......................License dt �.. -'- .3. Phone .T 46_-:. ' 4.0.7- installation will serve: Residence Q Apartment House Q Commercial OTraller Court El + Motel❑Other `k. ..... Number of living units. Number Number of bedrooms ------------Garbage Grinder ............ Lot Size ...-..•-- ---- •---- --------_--------- Water ---•...............Water Supply: Public System and n;me ................................._............... ---......................_.............................Private Character of soil to a depth of 3 feet . Sand 0 Silt[] Clay ❑ Peat❑ Sandy Loam Clay Loam ...... .... Hardpan Adobe 0 Fill Material ............ If yes,type (Plot plan, sh�awin,g,size of lot ocat!on of systei,in 'relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 0 feet,( PACKAGE-TREATIAIENT- I-1- SEPT44ANIC Q . .//.++, =____��--_ ......... Liquid Depth---- Capac)ty ... Type -- .. Material--- i. No. Compartments ----. 6 Distance to-red est: Well ---./_. . ... ...---Foundation ..--1©----------- Prop. Line -- --7........ J LEACHING LINE ( No. of Lines ....._ ` ` _ -..._�_.__..._ Length of each line-......1(4._....---_-- Tota! Length ..... J Filter Material . .........Depth Filter Wateriol ..l ..-�•-- - -- .•-.•-••-•-`--•-..--• �. r F N Distance to nearest: Well .-J0_0!.-3A'_..-- Foundation ....1-{[.-T........ Property Line _S.._-'t .._....._. t SEEPAGE PIT [ Depth -------------------- Diameter --- ..-...... Number ---------.._................ Rock Filled Yes No 0 Water Table Depth ................................................Rock Size Distance to nearest: Well ........................................Foundation'"""5............... Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................. Septic Tank (Specify Requirements) ......................................... .....- ......... .. Disposal Field (Specify Requirements) ..............................................•.-................................................................. ......... ........ .............................. ------------------------.------------------._:.............._ -----------••.............. -------- ............................................................... (Draw existing and required addition on reverse side) I hereby certify.that 1 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 Heolth�Dlstrict. Home owner or Ilcen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I slag I not employ any person in such manner as to become subject to Workman's Compensation laws'of California.' Signed --------------_ -- ------ ------•--- -- --r--- Owner BY : -• ---- 7it(e _._.__._-.. .'---•-.....-- --•--- (If oth r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE `�I-r'�!'� ------------••-•---------------------•- 6UILDING PERMIT ISSUED - --------------------•-••---•-----•-•----••- ----•---------- -----------DATE - --------------- ........ ADDITIONAL COMMENTS ---_---------•----•-•---- �..............._._.__......... - -- -- -..... :.: Fi al Inspection by: __-- -- - ------Date ...�--.a-41-_'1 .... . - -------------------- EH J'3 2h 1-68 v- 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M