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FOR OFFICE USE: I APPLICATION FOR SAHTATION PERMIT ......---: ......... .................. Tw- (Comple in Triplicate) Permit No. .� �... ...... .......................... ...............I........ This Permit Expires 1 Year From Date issued Data Issued . 17._3... 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 co'plionce with County Ordinance No. 549 and existing Rules and Regulations: i JOB ADDRESS/LOCATION r^.. ....... _. ....CENSUS TRACT .....................:...: Owner's Name . ..� �_ .. • It-'•I -.................................................... --. ...... Address ....... T �_Y�.__.� .•..��.�r��..-•...:......................... ..:city ...��:�.c,�'�o.�.............................:..:.......... Contractor's Name � - /�' a`? 9- •-•�•�• --•�-•• -----•...............•- -----.License # ��--��--- ... Phone . Installation will serve: Residence Q'Apartment House-E] Commercial ❑Trailer Court Motel ❑Other ..................•---••......._..._.._..... xj Number of living units.._..I____- Number of bedrooms __....Garbage Grinder .._......_.. Lot Size Water Supply: Public System and - name -•--- ..-••-..._................... . .•-•-••- _ _ ___.... .._ Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑� Peat E], Sandy Loam -E] Cloy Loam Hardpan ❑ Adobe ❑ 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 available within 200 feet,) PACKAGE TRE ...... Capacity .1 _..-- Type Material...................... No. Compartments ..15. ......... Distance to nearest: Well ......1>110-------•__.....--_•_-l--Foundation .. .............. Prop. Line _-.................... LEACHING LINENo. of Lines a [ ] .....��'--------------- Length of each line.__....-� ..... Total Length ...... _ :... 0 'D' Box .....L- Type Filter Material Depth Filter Material � !r ...._: � ......... ('? Distance to nearest: Well Faundati5n Property Line Z 7.._.;_... P rtY t'fl SEEPAGE PIT [ j DepthDiameter ed]... -./'.._ Number .........:Z.............. Rock Filled Yes 1j f No ' Water Table Depth -- Rock Size / t Distance to nearest: Well .... -�.-.�w.. ..............Foundation _. .__-_____-_ Prop. Line ......°.-._.._...... REPAIR/ADDITION(Prev. Sanitation Permit# ............................=----------- Date ...................................1 '(Specify Requirements) ................. ...._.._....... . ....... -------- - _. ........._. ........Septic Tan' . _ --:- Disposal Field (Specify Requirements) ............................'.�....�...------------------------------------�-�=:�........•-------'•------------....--•--------=- • a � .................................................. ........................ ..... _......................................................................_....:.._ ....................... i ----------1...........................................11,. ______. _ ----------------------------------------------- _...__._.__.__.....___.._.__.___._.___._. (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 ti County Ordinances, State Laws, and Rules and Regulations of the San 7oaquin Local-HWalfh—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, I shall not employ any person in such manner as to become suble to orkm 's Compensation laws of California." Signed ._-- r_ .................................................. Owner r ; BY ------------------------------------ ------------- •... Title ..............._._._........................................ (If other than owner) L- FOR DEPARTMENT.,USE ONLY APPLICATION ACCEPTED ......................... DATE -7��?.................. BUILDING!PERMIT ISSUED .. ..................•----- _.-•---••. --......`.. .... - :.w-:........:.....DATE ................... __.._.••...._--•••-.. ADDi AL CO ENTS _ ........... - "'—: - . � - rn/:, ..... ---- ....................... .... ........... . -••-- ........................................................•-•.......... ... ...--••- . Fi a Ins a tion by: _.-:---- ,.7y y_ . ------------------•---•--•--•..........--- --.....�...Dates. - J AQUIN LOCAL HEALTH- DISTRICT - -. / -. .E. H.13 24 1-'68 Re 7/723 ,4 A