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FOR OFFICE USE: - ------ APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No,76.` .. ... .... .----...... . This Permit Expires 1 Year From Out*Issue d Date Issuedr 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(...-�...cr9...G ....... CENSUS TRACT- Owner's Name ................4 .._.. ... ...................................................Phone 4.,:. i Address . ..... .�Z... . ............ -- C ty .... .................... ..............- �' 0.-•-2 Phone Contractor's Name License #vim..-,;` 3 - Installation will serve: Residence❑Apartment House 0 Commercial ❑Trailer Court 0 Motel ❑Other ... ,.C. _ Number of living units............. Nurnber of bedrooms ------------Garbage Grinder ...:........ Lot Size ... ............... Water Supply: Public System and name ----•..................................•-•--=-----......._..----....................................._........Private ❑ Character of soil to o depth of 3 feet, Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam o Clay Loam Hardpan ❑ Adobe Fill Material ....-...... If yes,type....I........I. ............ (Plot pian,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; 3 Size................................................ Liquid Depth ................... ...... Capacity ..... Tyle --•--•- ---=--- Material------------------ --- No. Compartments ........-............. . 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 ......................................a..... Distance to'nearest: Well ........................ Foundation Number ...-.... Property line ........... _SEEPAGE PIT [ Depth ......... .......... Diameter -__-------- Rock Filled Yes ❑ No �❑ Water Table Depth --- ------------ ................................Rock Size ................................ k - Distance to nearest. Well ........................................Foundation ------------ Prop. Line ...................... REPAIR/ADDITION IPrev. Sanitation Permit# ............................ ____________ Date ........ � Septic Tank (Specify Requirements) .Q- ��-•�..................r,�.Ytra-- -.---- Dispos laid (Spetify Requirements) ......... ........ r - rte.i...............__........ ..-.-.-.-.-.-.. ------------------- --------------------............................ ------- ..................._§ ".p. •------------------ - --- --- - .------- .......--- -- ---------- ._....................... -•---•----••...---•- ..•.. (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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed-------- ------ - •------ --- ---------. .._.. Owner By ---------- ------- ----------- ....... title .....---- (If other n owner) _ f9R D PARTMENT USE ONLY " APPLICATION ACCEPTED BY .-.. .. . .....-...- /Y`°'„'•---•-----•---------- ----------- ---------- - DATE '� . ---- R G - BUILDING'PERMIT ISSUED ------ DATE .....-• /------------------------------- ADDITIONAL COMMENTS .. .n�ki. .�.-..P:rC_.-..._. 1 `k . = --------------- -- . '. Final Inspection by. ---- ---•- .............................................Date .......1; ..�-6. Jai 13 2h 1-68 5 SAN JOAQUIN .LOCAL HEALTH DISTRICT 8/74 3M r _ r