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FOR OFFICV USE: 7�! . ,4 APPLICATION FOR SANITATION PERMIT z w• - .� Permit No. ..... --- ._........ ................... ..... (Complete In Triplicate) �. �. ................. Date issued . a . This permit Expires ] Year From Date Issued I ......................................................... ( . Application'is hereby made to the San Joaquin Local Health District for'a permit to consfruct and install the',work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:"'" 'f•(0'1`1? S' ' JOB ADDRfSS/l_OCATION Howland' Avenue & Louise ..":...................CENSUS TRACT .......................... ...................... Owner's Name . OXY Federal Credit Union Phone ..::858-2511.,,x .... 3 ... ............................... . Address _ P.O. Box 198 .._ ...................................................... • LathCa , 95330 5 ._-... _... .............. ...... .....___ •� Contractor's Name • ; : LJ Gl 4s .liaense # Phone 599 4902 Instolla#ion will serve: Residence Q Apartment House Commercial❑Trailer Court ] Motel [3 Other _..Of f ice__Trailor e - • - Number of living units------------- Number of bedrooms Gorbc a Grinder Lot Size -............................................ Water Supply: Public System and name - Occidental Chemical Co. ..- . _.••_-_-__.••,___•...::............Private Character of soil to a depth of 3 feet: Sand t] Silt Q: Gay n Peat 0 Sandy Loam [j Clay Loam 0 J Hardpan❑ Adobe 0 Fill Mcterlol ............ If yes,type ` (Plot plan, showing size of lot, location of systemr in relation to wells, buildings, etc. must be placed on reverse side.1 h NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! SEPTIC TANK �. a Size---...1200_Gal- ---- ••-••-...... Liquid Depth ........................... PACKAGE TREATMENT ( ] J Capacity Type Concrete Material.--•.................. No. Compartments ---.••.-••........---- ....--••------• ----•- Distance to nearest: Well ..Founda#ion Prop. tine ......................P Total Length 70 f t. LEACHING LINE No. of Lines _. Length of each line.-170 fv. g ...•................. • 1 -----_---- •••. � rr .� S`e t1C i�OCiC rr 'D' Bax ... Type Filter Material l 1/2 do Depth .Filter Material _...._..19...Deep.................. .__ t Distance to nearest: Well .......'.........:....... Foundation .........--........--... Property Line ........................ N SEEPAGE PIT ( j Depth -- Diameter' .--•-•---•:•-- Number ----------------............ Rock Filled Yes [3 No (3 Water Table Depth " . Rock Size Distance to nearest: Well ......foundation .. Prop. tine REPAIR/ADDITION(Prev. Sanitation Permit# ------------- -------- Date ---••-----•-----•---- ----•- ) Septic Tank (Specify Requirements). ................... •................... ........................................................ -- Disposal Field (Specify Requirements) --------------••• - i •• --------•------------------•- ----_- ..._._....----------------.-------......................... -- (Draw existing and required add ...... ition 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 focal Heallh'.DistAch Home Owner Or licen- sed agents signature certifies the following: t t "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 ,ject to Workmaam so 'on laws of California." Signed ....... Owner - litBy __ _._..,. i. a ----- (if other-than owner) i FOR DEPARTMENT .USE'ONLY t DATE .. T ` APPLICATION ACCEPTED B ! _. �� - __, ... -: - �CIO BUILDING PERMIT ISSUED --------------••'' --------- DATE ADDITIONAL COMMENTS -- :- --- 0_- -.employees--4 cT s a rieek ----------- ------------•--------- --------_--•-•---------- -•---- •---------- Tl.l ._. . ---�---l`---X�------------------- 5 g. . S'. -- '; Final Inspection by: 'f Date lh. .,/ ..--------• ------ EH 1.3 24 �--�� v• 5M'-44 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71t 3M