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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....... (Complete in Triplicate) Permit No. ._....._•______ 7 n -----;� v _--- /. ...�_ .7.... .....- ... This Permit Expires I# Year from Dale Issued Hate 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 ....,7_.99--Q......'-,`..Qrc.�,��.1Z-� 1 - .............................. ..................CENSUS TRACT .................... Owner's Name ... .T: ?...................................................,..................................... ..... P]aane ... . OCG y 6 S 711 G Address ... -�� (�--...�..-.. . ..oN7�.I',.0 ....................... .... City Contractor's Name r_1.£ `r ......................................License # _r`t,�.5� ..' .._ Phone ..5 O.Q.. 4..A.7.--- Installation will serve: Residence Q'4partment House 0 Commercial j]Troller Court 0 Motel (]Other ............................................ �1 Number of living units:... ...... Number of bedrooms ...V....._Garbage Grinder ............ Lot Size .. ... 3-...........--..�� Water Supply: Public System and name •.....................................----.......-•------,.. ..................................................Private Er Character of soil too depth of 3 feet: Sand❑ Silt j] Cla Q Peat j] Sandy Loam O Clay loam ❑ Hardpan jj Adobe NII Materlol ............ If yes,type ............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., must be placed on reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK{ } Size..............................•___........---.. Liquid Depth ...................._.... Capacity ------------ ----- Type .................... Material....................... No. Compartments ............._...... . Distance to neatest: Well ....................................Foundation"' ................... Prop. line ...................... LEACHING LINE j ] No. of Lines ........................ Length of each line.............................. Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............. ..........._....a---_-_ Distance to nearest; Well ........................ I=nundation _....._ ............... Property Line ........................ SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No (] Water Table Depth ....................... ..................Rock Size .................. ............. Distance to nearest: Well .. ....Foundation ... Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............. ................ - -� Septic Tank (Specify Requirements) ................................. ------------.......... ..... ..---.......... �r -- Disposal Field {Specify Requirements) ...../-Q---- .- ...... �-sY C�....-•---•¢--------Y-•-X•� • ----------------._. _-------------------------- -•-•--------------------------•------------------•-----•--..........------------....-----...........-•--------•--- .............. ----------------------........................................... ............-...................--............................. --------------------.... ............... (Draw existing and required addition on reverse side) I hereby certify that i have prepared this application and that the work will be dans in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Nome 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 .... alifornia." Signed -- -------------------•----------------------------------------------------------------•------ Owner By �� Title _... f... i s?��.7F�r, !f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B --- - ...- -- --------------- DATE L.-z ... BUILDING PE=RMIT ISSUED -------------------- .................... ....... DATE .......................ADDITIONAL COMMENTS ----- ........i ------I.... ....................... •---•-•------------------------- - ------------ ------------..............._... ---------------- ---------•-----•- :: :�'- - _ r Final Inspection by: .,._._� ._...._- .... - ... _..- Date .. .�_ t" EH 13 2h 1-68 flay SAN JOA IN LOCAL HEALTH DISTRICT 8/711 3M