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it FOR OFFICE USE: TION FOR SANITATION PERMIT .............. .. r r APPLICATION Permit No. ..72J..J-1S (Complete in Triplicate) r q ............ This Permit Expires 1 Year From Date Issued Date Issued . .��_........ Application is hereby made to the San Joaquin Local Health District for cl`'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: 108 ADDRE55/LOCATI6N .. . �_. ... 'f.Ja...... ...i....................................CENSUS' TRACT ............._....... ..... � . . ....r - .- ,rte_. -. '�.•�`r, �--.,�� F' �. �. _ .� - Owner's Name t...... .... ..... ..... Phone` 1`. . Address ..............••--.. 1.t�. ��..,..v .. City _._.._. .. Contractor's Name .................. ... ...... •--- -----------...License # .2—._ .3`t3. Phone Installation will serve: Residence`%Apahment House Commercial:❑Trailer Court 0 Motel ❑Otlier ..:............•----••------•-------••-••--- Number of living units:..... Number'of.bedrooms __..,7 Garbage Grinder ............ Lot Size .../Z. {{........ ..... Water Supply: Public System and narrtie __-"-- `.......................... ----------------------------------:1.Private E Character of soil to a depth of 3,feet: Sand'❑ r Silt❑ Clay ❑ ' Peat❑ Sandy Loam 0 Clay Loam ❑ ` Hardpan ❑ Adobe ❑ Fill Material _.. -------- If yes,type ............................ (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No. septic tank or seepage-pit,permitted.if.public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK.[ ] Size-•---------------------------- -- ---- -------- Liquid Depth .......................... LTI I Capacity .... '.:-:: Type .................... Material._..:-.-----------_-- No. Compartments a � Distance to nearest: Well ...................'"":_-zn.M_:_="Foundation....___..._....................... Prop. Line .. :p LEACHING LINE [ j No. of Lines ........................ Length of each line.----_----._............... Total. length - .................. ! D' Box Type Filter Material _.Depth Filter Material I f Distance to nearest: Well !........................ Foundation ........................ Property Line ............. ......... SEEPAGE PIT [-;% _Depth-,-,. . . ^:, Qiarneter Number ........................... .Rock Filled Yes No {� ........ - ❑ i <s. # Water`Table Depth' .T................. --+ --•--•..............Rock.Size ----------...................... " Distance to nearest: WellFoundation kk '- ------------------------------------- ----------- -.. . Prop. Eine .-•-----------........ � I REPAIR/ADDITION(Prev. Sanitation Permit# ........ � ................................. Date } y ' Septic Tank (Specify Requirements Disposal Field (Specify Requirements) t.... ----------------- /1 A . ....-.- .. _.. •-- ----- g ._..-ter..... . ......... .. ... - '- ............... (6rowexis in sand 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 Local Health District. Horne owner or licen- sed agents signature certifies the following: 1= ' "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 subject to Workman's Compensation`laws of California." Signed .................................... Owner By . Title ............ .. ------------_------- ........................ ......6LA........ ........................ f of r hon owner} EPAR7ME IT USE ONLY APPLICATION ACCEPTED BYE._ ..............................•-- .._......_.............. DATE .._., n BUILDING PERMIT ISSUED ...... .. --•-- ----------••-••......---•-........... •........._.. DATE ...............:.� ...••••••---------• ADDITIONAL COMMENTS ...:_. _.. 'tt. ..................:..:._--•------_-------•------------._._....................... = i ................•......................... ••....... .R_ :. ----------- -----------------•----• ::............_..._:•...-----•---•----.................-_......... •••._...._..._..............I---.. ...._. Final Inspection by: .... .. ... ... ............................................................•-•--...Da f .�. 7 ...-•-- to • .! � 1 SAN; OAQUIN.•.LOCAL HEALTH .DISTRICT v.a f i l=. H. 13 24 1.'68 R v -- 7172 3,4--