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FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT �J ...--- 1•__• Ir_ - _7�f Permit No. . .�`. -! A (Complete in Triplicate) ........._.._._...-"".................................i Hate issued This Permit Expires 1 Year From Date Issued 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/LOCATION i .�} ._ .. CENSUS TRACT ........ :.. f 1T_� / ......�I 6�s�.f�/!�P1_.�..��S..Lltt/��!+/Phon� Owner's Name 4W- . .FQ'-,,,.. G .. Address � ��u.�s�-.�� .---------------- . ....._ city Y ' .--- k '` license �S"f�-.7.3.. Phone Contractor's Name -_- �'/ ._ ' ! _- 's�t' �f._:_..: • Installation will serve: i� Residence Ej Apartment HouseO Commercial oTrai1�e Court 0F. s �: Motel ❑Other.. Number of living units-_-1..... Number of bedrooms .............Garbage Grinder ...... ..._ Lot Size Q- fir r Supply: Public System and name E Private ❑ Water Character of soil to a depth�of 3 feet: Sand Silt ,_Clay 0 Peat❑ Sandy Loam J_-] Clay Loam Q Hardpan Q Adobe[] fill Material ....----•--,if yea,typo ..........�.... .......::':. f i t f (Plot pian, showing size of lot, location of system in relation to wells, buildings, `ett. must be placed on reverse side.)� NEW INSTALLATION: (No septic tank or seepage-pit-permitted-if,public sewer.is available within 200 feet,) r PACKAGE TREATMENT ( ] SEPTIC TANK{ ] Size...... ?�__ ._X._��.F. Liquid Depth :...F��..:......:..... " v I . , . Materia)_ aVo. Com artients ..........Capacity «eA®_.._._ Type Distance.to nearest: Well .........?,j-0...................FoundatioA ./&.0........... Prop. Line ...•........ LEACHING LINE ( } No. of Lines --- ----•--- -------- Length of each line_..% ..•-- Total Length _ 7 ............. 'D' BoxLass�-_._._. Type Filter Material :�a�i_ ✓yt_•Depth .Filter Material ......�. ...........f� ........... ........ i Distance to nearest: Well _..�x� Foundation ....liQ.O-.�_..... Property Line ....- --`•-••••• SEEPAGE PIT ( } Depth --------•........... Diameter ................ Number ....-.........�............. Rock Filled Yes Q No 0 Water Table Depth ................................................Rock Size ................................ Distance to nearest: Well ...........Foundation .................... Prop. tine ••--•....•-•-•----•-f. REPAIR/ADDITION(Prev. Sanitation Permit -...........................___.............. Date .•.-__--.. .............. l Septic Tank (Specify Requirements) ......_.-•"--""-"""•---•..........'._...w......................................_................. Disposal Field (Specify�Requirements) ---"-----------•••-"--------• ---"•-"------------------ ............... .......................... "-""------------------ ----•------------__------ -----"----------------------------------- .....- ••-----------•-•--------- .. ""................•-""------...,...... ................ Ill' Ill �._ .............. \lDraw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will Ilse done In accordance with San Joaquin + County Ordinances, State ,Laws, and Rules and Regulations of the Son Joaquin Local Health:District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which.this permit is Issued, 1 shall not employ any person in such manner as to become lett to orktnan's Compensation laws of California." ' Signed --------- ------ Owner BY - Title ----- ._.... I lif other tha owner) ' I� _FR DEPART ENT USE ONLY I APPLICATION ACCEPTED;1BY .-- �'`.-.-_.. DATE .._:6.~ -G 7 6... BUILDING PERMIT iSSUED-y.. ��-__- - -- - AAT ----- - ti ADDITIONAL COMMENTS---------- Q '.:_...,. .. .. ... _. I ------------ --------------------------------------- -----•----------__ ii Final Inspection by: ..- Date ...--- -....7— s•-• EH 13 24 1-68 Revd 5 SAN :IOAQUI. LOCAL HEALTH DISTRICT 8/7a 3M