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FOR OFFICE USE: APPLICATION FOR +SANITATION PERMIT Permit No. 71 ►Complete in Ttiplicate) This Permit Expires 1 Year From Date Issued Gate issued If:P>r-?- C?_0--O 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 compliance with County Ordinance No. 5d4 and existing Rules and Regulations: I JOB ADDRESS) OCATICN.'--7�!`++�l+At :,E�•�_00C,�4 .. NSU TRACT .............. ...... Owner's Name ....... ...%J+e7.1!e....s ct� .. . .,Phone 7�_ G. ..... �1�..... City .._. _................... ...... Address ............. _..._... Contractor's Name .... ................ Phone ...... `Installotior will serve: Residence �Apartment House❑ Commercial []Trailer Court Motel L❑ Other ......... Number of living unitsc....�,..... Number of bedrooms ~'""..Garbage Grinder ....._..._. Lot Size ..... Water Supply: Public System and name ._......... - .._. ._ ...... �..._. .....Private Chcrocter of soil too depth of 3 feet: Sond ❑ Silt ❑ Clay ❑ Pea.1 ❑ Sandy Loam)z Clay -,.011 mm o _. Hardpan ❑ Adobe 0, Fill Material . �......... If yes, type .. _.-......!. _._.......__. (Plot plan, showing size of lot, location of system in relation to wells, bujidings, etc_ 1,must be placed on reverse side.) NEW INSTALLATION- (No septic tank or, seepage pit permitted if public sewer is available within 200 feet) I r1 `. �� ph PACKAGE TREATMENT `� SEPTIC TANK j I Size ,.�1'' X.�-'�'�3:...�r . Liqusd Depth ......,._...... ........ Or Capccityr?'I?` Type .,... MaterialNo. Compartments ............ k r i Distance to nearest: Well.. ..,,.`�.......................Four,datian .....i_$......_..... Prop. Line .-._.• r5�..._.____...._ LEACHING LINE [ No. of Lines .. ............. Length of each line... sqt ,*.... _ -... Total Length "� .............�.._ 'D' Box .. Depth Filter Material .... ✓.a�.,y�_....__.._......_ ✓ .Type Filter Material ._- ................ p .._..... Distance to nearest: Well Foundation .. _1.t) ............. Property Line ...... 1 SEEPAGE PIT (; Depth .........,.._ ..t. Diameter ......... Numbe; ........_. .._. Rockt Filled Yes M No Water Tabic Depth � • Rock Size .. Distance•to nearest:,Well ..................... ...Foundation _7t, Prop. Line ...................... REPAIR/ADDITION [Prev. Sanitation Permit #t - . _._ _ `........ _.. folate .......) Septic Tank (Specify Requirements) �.._��......'.._................................ Disposal Field {Specify Requirements) ..................................... ....... ._...................... ........... ......._,...................... ..._. _.... _.-.. _.. ......__.. ......... ....................., �..... ...................... s .._... ................... (Draw existing and required additiot, oda reverse side) " I hereby certify that I have prepared this application and that the work will be 4o'ne in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son JoaquinHome owner or lican- sod agents signature certifies the following: + z Cla ' ._ 1, `L I "I certify that in the performance of the work for which this permit is issued, I shall no bmp of y':any�person in such manner, .fi. J r &. ,- as to become subject to Workman's Compensation laws of California." Signed . _ Cwmer en By ��+ Title - •.. .._.... _..... r....-..�.-.._._..... (If other th caner) , OR CJ . _ ...._ FEPAR1i7,V5ic ONLY �1e -- APPLICATION ACCEPTED B`f. �."�&�tc�r.-�-- `�°�' < DATE ...lt�j!. . _ ......_... BUILDING PERMIT ISSUED _.......... '.. DATE ADDITIONAL COMMENTS .................... ........,....._....-_..................._. ....:......._..,...._... -.... .. .................... .......... ............. .......... F,no In by:. ,�! wr"r'Fs. � `................ Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 •'68 Rev. 5M