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� _ e �'— a»r —16��r•+�-�— - - �- — -rte... FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .�� ------ This Permit Expires 1 Year From Date Issued Date Issued �� .:. .7 lication is ereby the described. Thishappl application made in compliance with Couuin Local Healthnty Ordinance istrict for a No. 549 aermit to nd exact and install the work herein 40 d existing Rules and Regulations: JOB ADDRESS/LOCATON .3..74^..7-,. IL,�t/� 1, f� / ... LY= - ....CENSUS TRACT -----._. .- Dwner's Name .... . ... .. . ............. Address ..... .....:..... ... ' ............. ----- --------- ---....Phone _'51j4. . 1 Contractor's Name � - � ----- City .. ........ .7— .. '.�- �[.-`j-� -IL/......................... ..."�J.-�../��[ - •� , / SG_ �r C__<c...License # 1-2Z(f.2;.V Phone '3:.. •4� Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court �( Motel CJ Other .. Number of living units:_. �.•� - Number of bedrooms _..___---..Garbage Grinder ------------ Lot Size -. _. _ Water Supply: Public System and name .---- • ""f--_/ " r� ,q L i Private C] Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 �J11 Hardpan ❑ Adobe X 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; (Na septic tank or seepage pit permitted if public sewer is available within 2170 feet,) PACKAGE TREATMENT [ SEPTIC TANK[ ] Size...• ..... liquid Depth Capacity Type -------- --_.._... Material.,------ .._. No. Compartments ............ Distance to nearest: Well __"_....Fundation .. .. ....._._:......_ Prop. Line ... ................. LEACHING LINE [ ) 'D' o Lines Length of each line .. ... - . _- Total Length ..................._. D' Box Type Filter Material ___-.______----•---Depth Filter Material _........... . . Distance to nearest: Well Foundation Property Line SEEPAGE PIT [N Depth Diameter ..".12__ .. Number ........ Rock Filled Yes t6 No ❑ Water Table Depth .........- .9_V -----Rock Size _ Distance to nearest: Well .._..` .c/ • _ _.- Foundation ._.__...... .__-•.. Prop. line ." _�'.._..--_-• REPAIR XDDITlO Prev. Sanitation Permit# "-._._.. ._ ) ��.7r--- - --.... Date --------•--------<.............. . Septic Tank {Specify Requirements) ... .. ....... ... o ..................... Disposal Field (Specify Requirements) i--1 r+" -...----•----... .- .. -...-- (Drdw 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, I shall not employ any person in such manner as to become su je t to Workman's am nsation lowf:California." Signed . . �-------------.. Owner By . ---------- ----- Title ....... ...... ............ (if other than owner) ......... . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . _ -•---- ..... DATE 72: - --r_.._�G BUILDING PERMIT ISSUED ........_ . _.. ... .... ADDITIONAL COMMENTS .... .. 3 . .. ..... _...... ... ... ... ..........-...........-..................... ---------------I........_.................7......... .......DATE . ..7 ........ ...... --------------- ... ......... ........ ---._....... •-- - ..................... .......... ..... ....................... ........••-------...._. ----- ---- -- ------------- - ----- -----...... . ... .. ....... ---- Final Inspection b - . . . Rae. Date _. SAN JOAQUIN LOCAL 11 ALTH DISTRICT ` E. H. 13 24 1-'68 Rev. 5M 7/7 1 2 u