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FOR OFFICE USE: a. APPLICATION ICOR SANITATION PERMIT -..- -- ------ -----J`---- �; Permit No. (Complete in Triplicate) ?Z - ..�� ......__... ................................................. This Permit 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 described. This application is made in compli ce'With County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . '¢- . Clift • - 'a a -CENSUS TRACT .......................... Owner's Name ...._J_S./`!} 115119tI e---------------•----•-----•------.................------........._.........----•-------.Phone Address .................S.'T!niq----------,j •-•--•t �s n ---- --- City .k�..............................------............ , Contractor's Name .... _ - _►l--.J -�Y.._. _.._._-.--_----.License #It7Q+ _/_I_____ Phone . 4ab�_ A 1. Installation will serve: Residence(Apartment House❑ Commercial❑Trailer Court ;[] Motel ❑Other _ ....... If ,!! Number of living units:.. 1 __. Number of bedrooms Garbage Grinder ------------ Lot Size ---I-__AZ,-----------_.-____ Water Supply: Public System and name ._____..... _..............................................----------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ -Clay ❑ Peat❑ Sandy Loam Q Clay Loam [� Hardpan ❑ Adobe❑ Fill Material ------------ If yes,type ............................ (Plot plan, showing size of lot, location of system in rilatiton o wwells~buildings, etc. must be placed. on reverse side.) NEW INSTALLATION: (No septic tank or seepoK pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK SItNcl-- : Size------------------------------------------------ Liquid Depth ............... ._..,...-. Capacity .................... Type .................... Material-------N=—_ No. Compartments .................-^•� DistqLnce to nearest: Well ._.___., ___:_--- _ foundation ...............----_- Prop. Line ____________________+C LEACHING LINE [1�SNo. of Lines ........................ ..41h of each line ------ ----------------_- Total Length ............................ -�'D' Box ............ Type Filter'Materi i ....................Depth Filter Material �1_._�.........._....._.........,.....u. - Distance to nearest: Well'-__/ __ ..� Foundation .... �..;........... Property Line .......................5 SEEPAGE PIT Depth -_ Diameter __..._ti`j', Number .___ -_ -------- Rock FH1ed Yes No �' Water Table Depth r.-_-'•. .....::...........Rock Size --.- ----.-._----.-----_.._.. 1Distance to nearest: Well - ---- ......_._...............Foundation ................... Prop. Line .................... REPAIR/ADDITION(Prey. Sanitation Permit# ............................�..-.......(._ _ Date/.. ....... .............._..... - . I Septic Tank (Specify Requirements) .....}..._.....:. = ----------------A is- .. Disposal Field' ec,fy Requirements) -=-"�-0.: �'--`Q�•Cl�� _. .. 1_. .1_ ...--_..._...[.1 . - Q- ..--.---------------- -. .. ._.-.-.. (Draw existing nd'required addlitioril 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: ' "1 certifV7,that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to betomp subje4t to Workma 'A�Ccmpen ti" law of California." Signed tt .... . . AL ICY-. .. .... ...... ---••-- ------ By - ...-t -d- - -- ------- Title __ . .... (If other#han owner) PARTMENT USE ONLY APPLICATION ACCEPTED BY______ _______ ___,ll _ • BUILDING PERMIT ISSUED . DATE ...j/-�_7. -, Q.._.........._. 1.. -% ---•-•--•--._..... _ ..--••--.DATE ........................ ._....._......... ADDITIONAL COM TS .... - -...._ �.............. � .. e......................... - .-------- ------ qck. Final"Inspection by: __ - Qat ---......... --,�)-/-a-rt t - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M