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FOIL OFFICE USE. APPLICATION FOR SANITATION PERMIT .............. ... +� -•-- Permit No. 7t; X33 (Complete in Triplicate) This Permit Expires I Year from Date issued Date issued� '.�5... e� 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 _.fl�'7 z.C.0...../ar�f .. P.......� ......._... .......CENSUS TRACT .......................... .. _ . Owner's Name.�� / �. ,. . ,• ................:. Phoneocu. . Address _ 1. ....... City1.�.... %. ...... - -- - Contractor's Name _� l_ `�. ....._..-- --------.License # ........................ Phone .J;23..._..._....----- lnstallation will serve: Residence Apartment House f] Commercial❑Trailer Court ❑ Motel ❑Other............................................ Number of living units:.... Number of bedrooms ._( ....Garbage Grinder ............ Lot Size .._ .......�_.......................... Water Supply: Public System and name --------------....................................._.....................................................Private�. Character of soil to a depth of 3 feet: Sand)a Silt 0 Clay [3 Peat❑ Sandy Loam 0 Clay Loam Hardpan 0 Adobe 0 Fill Material ............ If yes,type............... ............ i (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) ' NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is availabl within 704 feet,) PACKAGE TREATMENT ) ] SEPTIC TANK i ] Size................... ............... Liquid Depth .........................9 Capacity ype ---- Mated ..................... No. Compartments -------......._.__..._ Distance.to nearest: Well ............................. .....Foundatio ... Prop. Line . LEACHING LINE [ ] No. of Lines ......... ............ Length of a line............ ............... Total length ........................ 'D' Box ........ Type Filter Material ... ................Dept Fitter Material ........................................... ,� Distance to nearest: Wel! ............... ....... Foundatio ------------------------ Property tine ........................a SEEPAGE PIT ( ) Depth .................... Diameter . ..—-------- Numb .......... Rock Filled Yes [} No WaterTable Depth -•------•---•• •---•-.....---•.......... .....Rock Size •---------------------------•--- Distance to nearest: Well __ ................. ..........Foundation .................... Prop. Line .....................9' REPAIR/ADDITION(Prey. Sanitation Permit ` ----------- Date ................. SepticTank (Specify Requirements). ......................... ....... ---------- -----..,......_..................-..-..--•-.....-•----...._...... Disposal Field p ci y Requirements) ................ .. ............... 406 '_.:.'..... ..__. ------------- ---••- / ---- ---- ,,7r .. . 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 Heatsh:Dlstrict. 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 become subject to Workman'sCorn ensation laws of California... Signed -------------•----- ------ ----------------- ' Owner BY --------- Title ---------------------.......---'--...------......-- •---._......... ...-- (if other than ow er) _ DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY .-. _ ----•---•---•- ------------------------------------- DATE ..� /.�-/-. �• = BUILDING PERMIT ISSUED -------------- --DATE --..........-------------------------------- ADDITIONAL --.--:---. ' - ----ADDITIONAL COMMENTS ............................-.............................................................................._..-•--------'•---------......................................................... --------------- ------------ ------------- ----- -----------------------....................... ............................................... ----------------• -- ---------------------•----•--- .... Final inspection by: - V " ------ ------Date ......`� -T-... .- ---- 1H 13 2h 1-68 &V- 514 SAN JOAQUIN 1O. Ai HEALTH DISTRICT 8/7h 3M