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FOR OFFICE USE. APPLICATION FOR SANI'T'ATION PERMIT ......................... (Complete in Triplicate) Permit No. .. '3.— 775 .......................... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora per 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 ...r C - ...... .............................................._CENSUS TRACT ...'� ...... OwnersName ......---fraa,G,^.Cr........ .... �rr_.�..��.�......................................................................Phone .................................... Address ....._. 1 ................... ..................................•-----......... Citye��f 1. ......... ................................ Contractor's Nome ,lf/ r ��f� ......License #r %` ��'G� Phone;. K,---V Z4K4' .. Installation will serve: Residence Apartment House 0 commercial❑Trailer Court C3 Motel C]Other ............................. •----•------•- Number of living units .- : _�_-_._ Number of bedrooms .._'...Garbage Grinder . t . Lot Size ` .................. Water Supply: Public System and name .-----------..............---••---...................-.----••...-•----------•--------•--...._.......Prlvate',k Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeA Fill 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 avtiilol le within 204 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK. ) Size..................................................Liquid Depth ......................... t l Capacity ................. Type •--................. Material...................L... No. Compartments ......................N Distance to nearest: Well ....................................Foundation ............ ......... Prop. Line ...................... . LEACHING LINE [ J No. of Lines ...... ............... Length of each line.---Y t_---:_.................... Total Length ............................ 04 'D' Box'............ Type Filter Material ....................Depth Filter Material --_-_._---------.----------------------- ... Distance to nearest: Well ........................ Foundation _.__ ................... Property Line ........................ SEEPAGE PIT [ ) Depth .................... Diameter Number ............................ Rock Filled Yes-0 , No [] Water Table Depth ........:.....•-------------.---------- --•----Rock Size ..................•-•---....,... lit p - i , Distance to nearest: Well ....Foundation .. Prop. Line REPAIR/ADDITION(Prev. Sanitation'Permit .................................... Dote ..........•.......................) Septic Tank (Specify Requirements) ........_--------.. ..... ............... ... ......... .. --••-- . ............. Disposal -Field (Specify Requirements) ..� ...•. " •------ i - -•--- - ........ -•.--....... ---. ••..••=-.... •-------------------• ---.......:.---•----........_.......------....--•-----•---.....-- ..................__..............................._................. (Draw existing and required addition on reverse side) 1 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.;Dlstric -Home owner or licew 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 became subject to Workman's Compensation laws of California." Signed -------•----- Owner r Y her than owner) FOR DEPARTMENT USE ONLY pp APPLICAT ON ACCEPTED BY .. ..... .......... .... .. .................................... ., DATE,?-—Q-7. i--------_----•--- BUILDING PERMIT ISSUED ................................••-•-••••---.........------------...._.....----------------------.........DATE .........---............................. .. ADDITIONALCOMMENTSn......................................................................................................................... ......I...................,------- --------------------------------------- ...............................................I........._.............................................................-•----...._......._.._......._._....._._............... -. --••--..._..--. -- _ ...... ... - ................... Final Ins action b ... ..........Dates � :.. ---------. p Y: ..- �cT,, .- - -_SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241•'68 Rev. 5M 71723 M