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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .76.�. 3.?- {Complete in Triplicate} .._........._..................... - 30 74 ............... This Permit Expires i Year From Date Issued Date Issued ..9._............. 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/LOCATIONj -©-.0..__- ...._ . :. - - - - -- �. . . .. _...._ _.. CENSUS TRACT ..-----•--•---..... - Owner's Name �.'{. ... `� 'c :....... ......:. ............... ..Phone .................................... Address9 City 67La' ........ ........ Contractor's Name - ._. --0�^e.4-icense # 4&3.9. hone ......................... Installation will serve: Residence ❑Apartment House❑ Commercial [Trailer Court ❑ Motel ❑ Other ....fi(�.----- Number of living units:.. ,_....... Number of bedrooms _..____.aarbage G index ...._. ..... Lot 5ize ..................... ............. Water Supply. PublicSystem and name -------------------•.-----. . ...---------- ------------ ------___..........................Private C] Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam m_Y I Hardpan ❑ Adobe E] 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 TREATMENT ( ],;SEPTIC TANK ] Size....___-------------------------------------- Liquid Depth ........................... Capacity .. ..... Type ..................... Material............ ......... No. Compartments .....................0 ' Distance to nearest: Well . ......... ....... .........Foundation ...................... Prop. line ------- k LEACHING LINE [ j No. of Lines .. L$ngth of each line Total Length ............................ � 'D',Box _...� Type Filter Material ........ ..........Depth Filter Material ............................................ ` Distance to nearest: Well ......- ------- Foundation ............. Property line .................... SEEPAGE PIT ( ] Depth . ....... Diameter .................. Number .................. Rock Filled Yes ❑ Na k Water Table Depth___....-..... .......................................Rock Sire .............................. { Distance tonearest: Well ------------------Foundation .................... Prop. Line :-............___.CCC... REPAIR/ADDITION(Prev. Sanitation Permit# ....:...........................•---------.. Date ---- ..................... ........................ -------.--- --.....--- ................... .....................9�Septic Tank IS ecif Requirements) .................. ................. Dis„osal Field (Specify Require ment ) . f ......................... ,.-............._............._-_--...................._...--------._-._._........-.---_------..........................-------.-.... ..................................... . (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 Joaqul 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 subject to Workman's Compensation laws of California." ._ I Signed - . ..----. Owner BY .... .......... ....... ..: ........... FOR - ... _..... (If other than owner) FOR D PARTMENT USE ONLY i APPLICATION ACCEPTED BY ........ ... ....... ------ ........ .......... DATE .... BUILDING PERMIT ISSUED __ _.. ....__........ - -------7-- ------- ........................._DATE ...........--•-........... ADDITIONAL COMMENTS _.............. ..... (i ......... . .......................................... -.-.----------_..........------.------------....-----•-•-•• ............_._.........................•----------•------- - . t - --- --------- ----- -----•....------ --------- . .-_----- - .._._.-_.....------•-- ...:.__..__.... �� Final Inspection by - ----- •...........................................Date . . ................... SAN JOAQUIN LOCAL HEALTH DISTRICT 'f l3 24 � - � � F E. H. 1-'68 Rev: 5M 7/723 ,4