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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ................ ............... (Complete in Triplicate) Permit No. .: S"_ ` S ........................................ s This Permit YearErom Date Date Issued .................... _......................................::.:.?. x . 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. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION .--- .g .._ �_. .__s CENSUS TRACT .............. Owner's Name . ... f ✓ .........Phone ....................... l� .Address City ' ��:'_��.�� Phone". Contractor's Name ...f.qE��..:��°o/.�.1._r-------------- ------------------ ---.License # '� Installation will serve: Residence-N Apartment House❑ Commercial ❑Trailer Court C) fM1 Qel ❑ Other ...._.... ......................... Number of living units:............. Number of bedrooms __/------Garbage Grinder /Y'G''.-_ Lot Size ..... ........... Water Supply: Public System and risme -------------- -•---------------------,.-- ------ ....--•--.---..... Private Character of soil to a depth of 3 feet: Sand❑ �,Silt❑ Cloy E] Peat❑ Sandy Loam ❑ Clay Loom 2g s �. Hardpan IN] Adobe ❑ - Fill Material ............ If yes, type . -------- --_.._.._._:... �f(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) o ~;PACKAGE TREATMENT [ ] SEPTIC TANK go Site-4/xfX:�..................... ..... Liquid Depth !P�................... i v`ex Sartments . .... ...........� ..--- No. CotCapacitYType - haterial � Or ` s T Distance to nearest: Well ..___.____........Foundation ......... rop. _ Line/,;? ...._.-. � ' LEACHING LINE JA No. of Lines Length of each line/dTlf................. Total Length J474................. �`,,�,, ti ` s, 'D' Box y.. Type Filter Material/-M&4 Depth Filter Material ,«..............��.....-.....6 t, Distance to nearest: Well .. ,Ke.�......__.._ Foundation : ............... Property line _._ ._ ......._ ........ SEEPAGE PIT u/J Depth . v��~,...- Diameter %?d:........ Number ..`.. .......:..--------- Rock Filled Yes,� No (] I iPp �- l .� Water Table De th "_..-.. .�........:.......................Rack Size - ..r- ,:_....._._..-:-_---• Distance to nearest: Well ../-VP------- __.. .............•_ Foundation Xe --- Prop. line Z9---_ _.._... icc �) ri, ...... i 'kEPAiR/ADDITION(Preva Sanitation Permit# .-----....-y ; Date ------------__ t Septic Tank (Specify Requirements) ---------- --�--.-�----------•-•-•-------•---•�• F ........ : ; ._.....---................- - - s • 'f to Disposal Field (Specify Requirements) "' --�` P --------------------- �(Drdw existing and_'required-odditio,n on reverse side} ".1 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 liven. sed agents signature certifies the following: "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." i SignedOwner ---•-- -- �... .. By . .. . .. - = Title . (If other?"n er) o `«� s F EPARTMENT USE ONLY APPLICATION ACCEPTED BY /i> .a.-. 6 DATE ....j� �..�r............... BUILDING PERMIT ISSUED .... -------- •-- -r-- -------- )........-.DATE ....... ................................... ADDITIONALCOMMENTS __....... ..... . --------------...._.._._.......__.._............................ ......................................... ------------_------------- .............. ..................................................... _......_........... ....................._ -------...---- - Final Inspection b Date-�:f:::.::_.:_.7-..----/ --•_----__ SAN JOAQUIN LOCAL HEALTH DIST RI c u 13 24 1-* ll 0— See 7/72 3 M