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.-- V.r1\.16 %F%M APPLICATION FOR SANITATION PERMIT ......................................................... Permit No. -74- ,7-T4(Complete In Triplicate) ........................111..1............ •.................... r This Penult Expires 1 Year From Date issued 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 compllance with C unty Ordinance No. 549 and existing Rules and Regulations: r JOB ADDRESS/LOCATIONw7V,e.11- i T�.......... ............ ..............................................CENSUS TRACT .......................... Owner's Name , .- � .. ..... .. ....................... Phone .................................... siddressl/z/. C�,�} .. ._ .......................City. ........................................... . Contractor's Name ....... . ..............................................License yZd-o26�7/C /..... f . installation will server Residence❑Apartment House Commercial❑Troller Court ❑ MotelOther . ----•-...................................... Number of living units:--. _... Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ----•...................••----.....................•. --......................................................Private Q� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ +� Hardpan❑ Adobe 0 Fill Material ............ If yes,type............... ............ d !Plot plan, showing size of lot, location of system In relation to wells, buildings, ate. 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 nearest. Well .Foundation . Prop. Line BEACHING LINE [ ] No. of Lines ........................ Length of each line............................ Total Length ....................... 'D' Box ............ Type Fitter Material ....................Depth Filter Material ........................................ Distance to nearest Well ........................ Foundation ........................ Property Line ..................... SEEPAGE PIT [ D Depth . Diameter ............... Number ............................ Rock Filled Yes ❑ No Water Table Depth ................................................Rock Size .................._.. .......... 40 Distance to nearest: Well •---•..........................._.......Foundation .........-----1111.. ProP• Line ..................... AtEPAIR/ADDITION(Prov. Sanitation Permit# .. Date ..................................� Septic Tank (Specify Requirements( ................... .................................p ..... 11....11 .......... _ .......... Disoosa! Field (Specify Requirements) ... --------Gt.QD,c eG .. ............. * ._ .... ...... ...................................................................... (Draw a stIng�red addition on reverse side.. q 1 I hereby certify that I have prepared thin appllcatlon and that the worts 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 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 bec subject to Workmkns.Componsaflon' laws of California." ones' �� •-- . Owner f� � f ..... ..... By ..... ......-1111.. �erthan (fes 1111. ..etc. ......------------ FOR . - Witte ...... ...... ... 1............................................. ( wner F R DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ...--.. ... ---•--1111_...................................................... DATE ..� . .. .......:..........::: BUILDING PERMIT ISSUED ........:....... ........ ...................................................................... DA?E>.:......... . ADDITIONALCOMMENTS ....... ....................•---------------------•---......-----•. ......---...-----.....-...------ ---.-- ..............................--------............ ------------ .....................................................................1......111.. ..---- ....- .... .... ... ............ final Ins ectian b ... ......................... ..................•.---.... .....-........ .Date � �... ... .. 2a 1-68 Rev. 5KSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H