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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........---• ............................I--.- .. (Complete In Triplicate) permit No. . --------------- .� { ........ .... This Permit Expires 1 Year From Date Issued Hate Issued .A. 9-7� 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: JOB ADDRESS/LO 5 ATION ..v1. � ._..�- py��--.��PE'Q.. _...... 134 ................CENSUS TRACT .......................... Owner's Name ..... C?\ ................................ .............................................Phone ..._..... ............... ---------- Address . . ...... .... ... ......... . -....----• . ..................... City ............................... . Contractor's Name .__. �1 1....00,ne-R-Je—TAC- t- 0Y.l, .-,;.license # .Z.351.x....... Phone .............................. Installation will serve: 1 Residence Q'ApartmentHouse 0 CoLm�m�erc !QTraller Court 0 Motel ❑Other ............................................ Number of living units-1------ Number of bedrooms _. Garbage Grinder ............ Lot Size . Qc ....................... Water Supply: Public System and name ------.........................................._........................ ....................................Private [JJi Choracter.of soil to a depth of 3 feet: Sand C) Silt❑ Clay ❑ Peat❑ Sandy Loam ar, Clay Loam ❑ Hardpan 0 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.)1-3 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) v PACKAGE TREATMENT ) ] SEPTIC/TANK ] Size-.10i>--S. A:10(--- ---.-- Liquid Depth ...4................... Capacity � Q-------- Type 85.71 -------- Material_ Pe?e ...... No. Compartments .-...D.............. Distance to nearest: Well , .( ......................Foundation/0................... Prop. Line ......... LEACHING LINE [ J No. of Lines --7Z---------------- Length of each line.... '................. Total Length .-/;?a".............. 'D' Box _..._ _... Type Filter Material .- - •-1�.'�=.__.Depth Filter Material Ze ............................ ..... Distance to nearest: Well ...... Foundation .��`................ Property Line f . . ..... SEEPAGE PIT ( } Depth ....... Diameter`?-eV-l-__---- Number -.2...................... Rock Filled Yes Q" No C] Water Table Depth - --•---------- ......Rock Size ..lz� V-41- -...... yf Distance to nearest: Well A .�-------------------Foundation ....... Prop. Line ..�. REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------------------------------ Date ........- ............. SepticTank (Specify Requirements) --------------•----------------•--- .......-----------------------------------•---------------.......------------- ............. Disposal Field (Specify Requirements) ------------ -----------------•--......._............-----•-------------••-•----......._....... _. -------------------------------------------------------- --• ------• -----------------------:--------- .........................•.............__........................................ . (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dono 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: "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 � ' ---------- . ... .. ........ (if other an owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- --- - --- -� "- ------- ------------------------------------- :---------• DATE .......f...� _.��ti_.......... BUILDING PERMIT ISSUED ..... --------------• .._. --- • ---- - DATE ADDITIONALCOMMENTS ------------------------------------------•--------------------•------------------••--- ----------------------------- --------------------------------------------- ----- Final Inspection by: ----------- ' - --------•------------------------------------Date "Y/77-- Eli 13 2h 1-68 Rev. 5m SAN JOAQUlN LOCAL HEALTH DISTRICT 8/7h 3M c