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FOR OFFICE USE: : APPLICATION FOR SANITATION PERMIT • 61............. _.......... Permit No. .._..75 (Complete in Triplicate) --••.•.... ---------------- This Permit Expires f Year From Date Issued ©ate 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ....1' � . .. l G-D. •�.iL ?. .. ......... ............CENSUS TRACT ........._........ ....... Owner's Name [= _ . ........................................................... {'T._. '�4j� Phone ?�.?g. ....... Address ...... �' ... . .�< ... l-:... . . rJ��..`� - _...... City V.1145—.4f.14.......................... _ �1 1 F F A•- -..... -------------------License # 7�-s �------ Phone..�3f"n—& . Contractor's Name .- . _ ,. .. � L� t�-_-_ Installation will serve: Residence [/Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑ Other ....... ....... Number of living units:..r------- Number of bedrooms ..'S------Garbage Grinder Lot Size .._�3__ ------------------ Water Supply: Public System and name ........................... ........ ............................. ..........................................Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam 0 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 TREATMENT [ ] SEPTIC TANK I ] Size......--------------------------------.... ._.. Liquid Depth ..........................r Capacity ... . Type _.- ......... Material........ .... .... No. Compartments J Distance to nearest: Well .. ...................Foundation .......--- Prop. Line ------.......-.-.... G LEACHING LINE [ ] No. of Lines Length of each line ...... . .. ........ .... Total Length _..., ...................... 'D' Box ..... Type Filter Material ....................Depth Filter Material .... ....................----•-----•........01 Distance to nearest: Well ........................ Foundation ................. Property Line ................ SEEPAGE PIT [ ] Depth . ........ Diameter ................ Number - -.-.. .. Rock Filled Yes ❑ No ❑E Water Table Depth --------- ..". ------- •-----------------Rock Size ................................ r, Distance to nearest: Well ........................................Foundation ............ ....... Prop. Line ... .................. REPAIR/ADDITION(Prev. Sanitation Permit# -------- --- ---- -- --------------------- Date ----------------------------...--_I Septic Tank (Specify Requirements) ... . .. .-y.. .-.--.. • •.... -----------------•----..................-----............------------.•----............I........ ... •- ` �, ' Disposal Field (Specify Requirements) -- ...is_.<-� li .----ASD ---_.., 6---.. -/_.c'.ig. '--. .�,rr�. ?................... -- -------- - - - ---- - - ----------- - -- (Draw existing and required addition on reverse side) r 1 hereby certify that I have prepared this application and that the work•will be done in accordance with San Joaquin r 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 became su jeet to Workman's Compensation laws-of California." { Signed . « -----------. Owner BY ........ ... ... --- ...... ._. Title (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - DATE4__h'�.-..................... BUILDING PERMIT ISSUED ----- .. .-- ADDITIONAL COMMENTS .. _ .. __ _................. . -- ------- - ----•- _ - ....--•----..... --------- -- - - -- --------- -- - ----------------------- --------------- - -- ---- --------------- Final Inspection b - -�? p Y; •----- --- - --------- -- .Date . ��~� SAN JOAQUIN LOCAL HEALTH DISTRICT.. a E.. H. 13 24 1-'68 Rev. 5M . : 7172 3 ,K