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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT ........... .................. Permit No. ..76 r:.,?_.,1.�' , (Complete In Triplicated .............. .........?..... ..._. This PennitExpires 1 Year From Dahlssued Date Issued 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. 519 and existing Rules arid r, ` Regulations- 'AT ulations: AT N _ _ � ...........cENsuS TRACT --JOB ADDRrSS/ OC • lY. Owner's Name . ----- ....��.... . /tl v.�..,+r::� :� Phone .d? � - r:_ ,. ._.... �J. �1..:Ci ._... _ .'�� -.. ty ----------------------------- Addresst. � .: � Q '1 .:.......:...:......License . .= ��--- Phone Contractor's Name------------- --- •----._._...._........ Installation will serve:. Residence 0 Apcirtrnent HouseO-Commercial QTraller-Cmd-13 Motel ❑Other'---........................ ........................ �. �-: r i 31 r �►, Number of living units•.... Number,.of bedrooms _..- ...._Garbage Grinder Lot Size -�� --- Water Supply: Public System and name ................................` __.__.� -'. e,-,c ...................... © ------ I' - , _ a SOI Character of soil to a depth of 3._feet:�...Sand-Q-�.YSilt-❑ Gay (] ; Peat Q Sandy Loam Q Clay Loam i Hardpan❑ Adobe 0 Fill Material ..._..... If yes,type............... ............ f (Plot plan, showing psi a f�lo , loca#ion of system in relation to wells, buildings, etc. must be placed on reverse side.I�_N. NEW INSTALLATION: tNo septic tank or seepage pit permitted if public sewer is available within.20 feet) „ PACKAGE TREATMENT I l SEPTIC TAMC ' ... ... ..........•.............. Liquid Depth __ .::------------ Capacity Type 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 -------------- -- Distance to nearest: Well _________________________Foundation ___-_..___-.__.__ -:_... Property Line .._:.. SEEPAGE PIT [ ) Depth i Diameter __-.•_---.....: Number ................:---........ Rock Filled Yes ❑ No Q Water Table—Depth.....................................................Rack Size ........................':.. Distance to nearest: Well.................................:......Foundation .................... Prop. Line --------- ._...._... r ' { REPAIR/ADDITION IPrev. Sanitation Permit' ._...................•- --•------.:..-. . Date --___--:- Septic Tank {Specify Requirements).-- -�- -i _ :.:... .._ 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 I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health:Dlstrict. Hants owner Of 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 maturer as to become subject to Workman's C.o_m,pensation_laws-ot,_Califomia.'_' N Signed ...... ....:............. _ ......... Owner __. --- ----- e . ........... . ................................By ...... (If o r than owned FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ........... ..:.. �---- /� •_.:._....... DATE .- - -�, ----•-----••- - BUILDING PERMIT ISSUED _....:. _______ _________________:---••-•..v' .. DATE -. ADDITIONALCOMMENTS -----------------------------------__--..................................................... ----- •--•----•--------------••---:----------6......---•----.. ------------------------------------ -------••-_.--......... .......................------------ .......-............ o .- -------- •----•--- ----------••- .......... ......... ............................ ............. ---- ----- ,..- . _ Final Inspection 6y: ._...- •--•----••..................._._Date ..-.....------ ..... EH 13 24 J--68 tLev�5M SAN JOA IN LOCAL HEALTH DISTRICT 8/7h 3M