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FOR OFFICE USE. . APPLICATION FOR SANITATION PERMIT __....... ... _---------- -- 3. IComptetein Triplicate) Permit No. .__7, ............37 This Permit Expires t Year From Date Issued Date Issued ..:.....}:.. .76 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 Reguldtlbns: t`Co ti/G4` E JOB ADDRESS/LOCATION a K�d-04CENSUS TRACT ....Q6. Owner's Name ...... ................................................................Phone Address /4k©p ... + •-_•..._. City _✓F.9.....44.:��..__.... .....--_ Contractor's Name -.-- _-- ,�+i i!PH---✓' V-t--- C..f.......................License # 7�'Q. Installation will s ry Residence[I Apartment House Com ercial railer Court ❑ Motel Number of living units:_.iO----- Number of bedrooms ..6......Garbage Grinder ... ...... Lot Size Wafer Supply: .. � ..1��G'-�.. ....... PP y: Public System and name ........... ..••---•................•-•--- ........._.........,........Private Character of soil to a depth of 3 feet: Sand 4 Silt l] Cloy p Peat C] Sandy Loam fl Clay Loam ❑ Hardpan❑ Adobe 0 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.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! PACKAGE TREATMENT f ] SEPTIC TANK i Size. .............. ........ Liquid Depth .. Capacity W-0-0- ..__-- TYpe -.404 . Materia�i�°r t, No. Compartments . ..... Prop. Line .. . I LEACHING LINE [ No. of Lines ...___.-••-----_------- Length of each line......]............. r Total Length ._..cam................ -. 4 'D' Box ..- --_--- Type Filter Material .C A.--_•-.....Depth Filter Materlol .._-f9-00. Distance to nearest: Well ..,/_�d�. / .......................Faundatian ._..--- .. rff .............. Property tine . .�.............. SEEPAGE PIF . { ] Depth ---------_ ----... Diameter Number ---.�.._... .......... Rock Filled Yes ❑ No Water Table Depth - ...........-.........•.......................... ck Size Distance to nearest: Well .............. Foundation ...... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit # ..........----. ...................... Dote _�.................. •----...------) Septic Tank (Specify Requirements) _______________ " Disposal Field (Specify Requirements) ......................... . --------- ...... ..........• --------•---------••- ••-----•--...----••--... . ----------------------------•------------ --------- (Draw existin and required addition on reverse side)w........................ •-------- -...................... : I hereby certify that 1 have prepared this application and that the work will be done in accordance with San JooqulW County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health-District. Home owner or iicen- ' 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 an as to become subject to Workman's Compensation laws of California." p y Y person In such manner Signed - - ---------------- - - ------••----------------•-•-•-------.....-•-----••---- Owner BY ----•--•------ Title ... (If other than owned .._................................. FOR D PARTMENT USE ONLY -. APPLICATION ACCEPTED BY ._. BUILDING PERMIT ISS ED -.. e` DATE ....-.�. ._��L." .` , .....--•---.. .. ------• ---------- ---DATE - - ADDITIONAL --COMMENTS _-.------t._---------'---------••-•---•-- -------- ----------- ----------------------------------- ----- ------------ - ••------- - -----••.. ----- -. --0,0 ---•--------------- -----------•----------- .._............---------•------------•------------------------•- -- -- -•---•- ....................... Final Inspection by: -•__-- -- -----_-.-- -•--" EH 13 2L 1-68 V Date ..,/ .�.� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M