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h n FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............... 0.. Permit No. ..�`f`:--`s�-. .... -- ' ----_.... - -. .... (Complete in Triplicate) Date Issued . `�...7`S.. ........ -.`:............. This Permit Expires 1 Year From Date issued 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 mode lin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .... .8--- , ...... ./._..-... G� �---.� �.._...-.-CENSUS TRACT Owner's Name ...... P Phone ........................... Address City ... ---- -----------••••..._.............--_... '1k----------Z- Contractor's Name . ..._.License # 2�-61 .1..... Phone0-[------ Installation will serve: Residence [Apartment House❑ Commercial ❑Traller Court 0 Motel ❑Other ............. _------------- � Number of living units:..._./.. Number of bedrooms ...;.X--Garbage_ -' Grinder .. 3- Lot Size _ze,9... 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 I( Fill Material _........... If yes,type ............................ i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mustbe placed on reverse sided ' NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK f I ,6_X1 T"� � ----------------------- ........ Liquid Depth .........--- Capacity ... . ...... Type ...... ... Material...-............ No. Compartments ..................... � Distance to nearest: Well .............................Foundation _......._...._.... --- Prop. Line ----------- ......... LEACHING LINE No. of Lines . _/ _ -. _ _. -. Length of each Total Length --.-6�0--f......I 'D' Box ----- ..... T eZype Filter Material . . _ _ DepthFilter Materia! ..1� ----------------•--.__.rDistance to nearest: Well _. t ............. Foundation ...��._ ......_. Property Line .�.---. ---1..SEEPAGE PIT Depth ./-.-. Diameter. ..1�. Number _... ------------------- Rock Filled Yes NoWater Table Depth 1� ----....Rock Size -. ...................•---.Distance to nearest: Well ../. ...........................Foundation .. ._.... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ..._.............................__....... Date ----------------------------------I Septic Tank (Specify Requirements) -------_---- ---------- ------- ....... $ ` e Disposal Field (Specify RReeq-uir�e/ments) .-. -- - - ---- - ----. ----------------. ----- ..................... .._...-----------....................... ..... (Drdw 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 total 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 nN employ any person in such manner r as to become subject to Workman's Compensation laws of California." ` Signed .:.:.. . ... ...... Owner _ LBY s-4�''L`---- •---.. Title (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ........ DATE .. 7./..J-./7 S------------ BUILDING PERMIT ISSUED ................ ... ..__.... ...-DATE -..----- --- ADDITIONAL COMMENTS ......__ .. ........ .. . . .. ... ------------------ ...... .. ............. --- ------------- Final Inspection by: - ----------- ------------ Date :.. . -'. }: -1..75✓..... SAN JOAQUIN LOCAL HEALTH DISTRICT_ 7/771 k