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FOR OFFICE USE: ............_....._..---••---•- APPLICATION ICOR SANITATION PERMIT ............. _......----- Permit No. .7:s.. 71...... (Complete in Triplicate) ................... ............................ This Permit Expires 1 Year From Date Issued bate Issued .,� ..:7s.. 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 ._...3¢ 9,,0..._ cC�ar:✓...-CENSUS TRACT ..... Owner's Name ........ -�✓f.� ,/V ! ....................... --•...---..........Phone .................... /� T�� Address ... .�D-so-- � -.-�,�---• --C.-��.�T�.�9.-•-.��•-��'-................. city ..�i4f?f....... ..... .-..e..:. ......................... Contractor's Nome .......License # -¢../.. Phone .....0 -4.44! I � Installation will serve: Residence❑Apartment House Commercial❑Trailer Court Motel ❑Other ............................................ Number of living units:__._4a. Number of bedrooms .......Garbage Grinder ........ Lot Size .............................I...... ....:... Water Supply: Pubfic System and name ........ ....................................................................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Cl Adobe f=ill 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.[ 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 .....................0 Distance to nearest: Well ____________________________________Foundation --------------- ...... Prop. Line ................ LEACHING LINE [ ] No. of Lines --------------------- Length of each line----------------------------- Total Length ............................ 'D' Box ------------ Type Filter Material -------------.......Depth filter Material ........................................... .� Distance to nearest: Well ------------------------ Foundation ...............--------- Property Line ........................� SEEPAGE PIT [ ] Depth -------------------- Diameter ---------- Number ... ........................ Rock Filled Yes ❑ No r1c Water Table Depth ................................................Rock Size ------------------------------•- Distance to nearest: Well ........................................Foundation ----------_--------. Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ................................-.) SepticTank (Specify Requirements) ---.......................-...........-..........---------------------•-----------------••----.......................... .............. (Specify Re a f p . Requirements) _..�-�_r..Slrtlf------�s2__x. .__.��"....X_�"_.-•��'��..?-. .. Di osal Field (5 Y uirements .....'7 ............................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work 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, t shall not employ any person in such manner as to became Jett o arkma 's Co pensation laws of California." Signed ---------- ----------- Owner By --------- ;-� � � ---- -- ------- Title -- ------------------ ---------- oth hon owner! FO EPARTMENT ONLY _ APPLICATION ACCEPTED B - -. ----------- DATE ...�.` -- .... BUILDING PERMIT ISSUED ______________ ----------------•-•-------------------------------------------------------------------------DATE - -- -- --•---•------------------- ADDITIONAL COMMENTS ---------••----•--• ----............................................ --• .- •• -------- ---------------------- --------------------------------------------------- Inspection b .............. --- Date �?/�#:` 7r� p Y -• .... -- ---- ....... / EH 13 2h 1-68 v. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M 1