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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ._7 ` This Permit Expires t Year Prom Date laDate Issuedced 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 ex #inZgR les and Regulations: JOB ADDRESS/LOCATION .. ..6,._76.... ..... .. . ... •. -•..... .. ••..-CENTRACT ......................... Owner's Name ..._ /..f ..._ - ....................._..._..:_....,_........ .67-6 .7�.. ........... Phone .................................... Address s !` City .... Contractor's Name ...license #c V Z-?Pnone - Installation will.serve: ResidencoAApartment House{] Commercial❑Troller Court ❑ Motel ❑Other ............ ............................... Number of :living. units:-../ Number of bedrooms .._ ._Garbage Grinder ........,... !ot Size Water Supply: Public System and name .......................................... ..r. =• ..............................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loom {3 Clay loam Hardpan❑ Adobe fl Fill h0twiat............If yes type............... ............ (Plot plan, showing size of lot, location of system In .relation 'to wells, buildings, etc. must be placed an reverse side.) E NEW INSTALLATION: (No septic tank or seepage pit,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT l ] SEPTIC TANK;j ] Size......................... ................-.- liquid Depth ._..._ ............ _ X IsTo/cl Capacity ----. ............... Type ..................... ftiteriat...................... No. Compartments ....................... Distance. to nearest Well unds#ion ........ Prop. line .................... ... I LEACHING LINE [ J No. of Lines ...... ................. Length of each ................ Total. length ...6.C.?................ K t57'i,i1 c� 'D 8ox6ff?1j..-_ Type Filter Material �Zi�_ls�...Depth Filter Material ----/6- ..f:........ : . .... r Distance to nearest. Well ..._Foundation _....._..::_._.. Property line - SEEPAGE PITe Dr t 1 p ......... Diameter .. -__._. Number Rock Filled Ye: No �] Water Table Depth 8,t`1...__._ - D, .......:.....................Rock Size I=a?Ar,/..� ........ ! � ' Distance to nearest: Well ....,l-0f?...,_....,___-„,-......._Foundation ._./f1_._........ Prop. line .Z.-I............. IIEPAIR/ADDITION(Prov. Sanitation Permit# i ........ ................ we ................. Septic Tank (Specify Requirements' t2Z.- Disposal Field (Specify Requirements) .._..._ 1.... .... ..... -------••---- ----•----------------------------•----------•-•-•----•----- ........._,.....................................................:........................................ (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 accordant* with San Vin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heolth:Dlsfdct. Home owner or Iicen sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is Issued, I shall not omploy any person In such man”" as to becom blect to W rkma 's Compensation laws of California," Signed V. • -- -4--A - -- --------.._ Owner By ..._- •-------- Title - (if other t n o r) - . .. . ...:.. ................--._..._:..__ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _- -- DAT): P:._`_ �r�4-` --. 8lJ1LD1NG PERMIT IS _.. --------------- ------------------------------- - ------------------------------------DATE ....... ------.._.._...... ................ ADDITIONAL COMMENTS ............................... --- -----------------------• -----....._. ................ • - ----------- .......... --.................... ----- •. ---.--•---•• • -- .......... --------------- ......... ------------ ----- --- ..-----• final Inspection by: -- -- ------ --- ,tea -------------- --------- .................................--•--Date�.d..: ... ........ .. i EH 13 2h 1-68 ltev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M $;