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FOR OFFICE USE: ----------------- ----------------- APPLICATION FOR SANITATION PERMIT J ---------I ---- ------ (Complete in Triplicate) Permit No, --- ---------------- This Permit Expires 1 Year From Date Issued ---- � - - bate Issued _�-_��73 -• Application is hereby made to the San Joaquin Local Health District for a i described. This application is made in compliance with County Ordinance No. 549 and existing lestathe work herein ann d Regulations: JOB ADDRESS/LOCATION ._-_ ....67 f � ENSUS TRACT . Owner's Name -___ . [ Address -_.___- ----------------- , e--_e-------- -------------------------- Cit ? Contractor's Name ------- Y ----- - -------•-------•- 4 --- P� -- _____.License # Installation will serve: oZS`�L7?_ Phone ______----_--------------- sidenceXApartment House❑ Commercial [DTrailer Court ,M Number of living units:_._ Motel El Other -------------------------------------------- f------ Number of bedrooms .3-------Garbage Grinder ------------ Lot Size ...4�-_ Water Supply: Public System and name - --------------------------------- -- -------Privat Character at soil to a depth of 3 feet: Sand'0 Silt.[ Clay ❑ Peat❑ Sandy Loam E] Clay Loam;❑ f. Hardpan )( Adobe.❑ Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be la NEW INSTALLATION: placed on reverse side.) p,. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT { ) SEPTIC TANK' Sizer y � [ ) --- ----�.x_ --°----- ----- --------- ----- - Liquid Depth ---- � Capacity _./. -Q0----- Type - - EA-4"T Material---CO-- - - %1_No. Compartments ___ - __ N Distance to nearest: Well ------ - __ ____________Foundafiion _.._1�--_t--._ Pro Line _- LEACHING LINT= P• :..._____ � { l No. of Lines __-_. __._________ Length ofeach line. ------------ Total Length _ rG�Del D' Box Type Filter Material - �,T _ _--_Depth Filter Material �r Distance to nearest: Well ---1 - __- Foundation ____Zo r ------------- Property Line_ ---� SEEPAGE PIT 1 - - --------•----- [ ] Depth _ - -- __- Diameter ~� - --------••�--_-- Number ---- --�, _ _-- Rack Filled Yes No i❑ - --------- Water Table Depth ------- -r .________.__Rock Size _. � ------i Distance to nearest: Well ______ -PC !C ------------•- Foundation XQ-------•---- Prop. Line -----7'�------- Septic Tank (Specify Requirements) ----------------------------------------------------- ____________________ y' REPAIR/ADDITION(Prev. Sanitation Permit# ________ ______________ _ ---- ----- - ------ --- bate ---- -------- -------- - - ---) -------------------- isposal Field (Specify Requirements) -( - -------------- --- - -Draw existing and required addition on reverse- -sid-- -e--- ) -----------------------------------------'--------------- 1 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. 1 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 becom ct to Wo kmpn' Compe ation laws of California." p y Y person in such manner Signed ._ --_ -- ------- zJ� __ Owner BY - R - G. Title [if other th o ' ed P MENT USE ONLY APPLICATION ACCEPTED BY --.__-__ [ BUILDING PERMIT ISSUED . -------------------------------------------------------------•-----. DATE ----- -- -- ---- -------------------------------- - --- -- 3 DDITiONAL COMM NTS --------- DATE -------------------------- L,r - - - ---------------------------------••-- �_. --- -------------------------- - - ---- - ----------------------------f------- --- --- ----- ------------------------ - - - ------------------ Final Inspection by: _- ____ s '---------------------------------------- ------------------- -------.Date ......6- n - ------------ AN JOAQUIN LOCAL HEALTH DISTRICT jr E. H. 9 1-'68 Re 5M