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— FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT Permit No. 7.4... ................ & �,7 I ----•--..._.... (Complete In Triplicate) ... . .. . 6 �6 Date Issued .�...�........... ........ This Permit Expires 1 Year from 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 rdinance No. 5444 and existing Rules and Regulationst JOB ADDRESS/LO N .. . ... .. ......................CENSUS TRACT .................. . Owner's Name ....... s....... _ -----------------•---............... --------•----- ..Phone .. iP - Address _ '71°` " --------•-•- City fContractor's Name * � � ........License #��12�.�-- Phone Installation will serve: Residence partment House C3 Commercial[]Trailer Court 0 Motel ❑Other ----------------•-------------------- Number of living units_____________ Number of bedrooms ._�--Garbage Grinder ............ Lot Size r ............. Water Supply: Public System and name ..Private [$� Charocter of sail to a depth of 3 feet: Sand 0 Silt❑ " Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 ; 1. ` Hardpan Q "'Adobe[] fill Material __.......... if yes,type ............... ............ ' (Piot 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 Ij ] Size.... ........... Liquid Depth ----S.-_..-`............ �1 _ • . C ............ Ca acs vt-� ------ T _ Material � -_' No Compartments. �� .-Capacity yp li Distance to nearest: Well ._!-c e-9 ion � .---•----- Prop. Line ---- ---..... LEACHING LINE No. of lines --- Length of each line._......-............... Total Length ...-.-•_--- ...........---'0 [ .... lJ _.....Depth Filter Material `D' Bax ------._.... Type Filter-Material _ -•_ . Distance to nearest: Well ------ ........ Foundation .__......_. .....::_.... Property Line......:.._..--...........I (b SEEPAGE PIT [ ) Depth -------- ...--- Diameter ................ Number ..__.."--.. ..... Rock Fillet) Yes ❑ No 0� Water Table Depth -------------•-------_,........................Rock Size ------------------ •--••--- V1. Distance to nearest: Well .-----_----.-_ - ---........Foundation -------------------- Prop: Line ......................V' REPAIR/ADDITION(Prev. Sanitation Permit ..................................... Date _.--.-_- ---•-- -) __.._.. ........... I Septic Tank (Specify Requirements[ ..... ........ �u ` .. ..._.1.... Disposal Field (Specify Requirements) '-"----- . ------------- ---- .... f �� -------------------------------------------• ---------• ........................ . _. �. a .....--}-------------•---•-----------•---...------------......------....----- ---------------------•--•---------------..._..-- -------...-----------•---._.......---•--. - (Draw existing and required addition on reverse side) thereby 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. Hoare owner or licaw sed agents signature certifies the following: G "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." Signed ....-. -----------------•---•----------- Owner Title _.._ ...... .----------------------------------------- ------------- l E (If other than ow r) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..------- ---• - --- ----- -- ------------------------------------------------------------ DATE ... .. ��_.__.-...,. BUILDING PERMIT ISSUED _ DAT ...----.. _ .. ��` 5 ------- ADIJITIONAL COMMENTS .-- ,r_-_-.. s ..__r _.., 9�.___.-"" "_-_. �� .. ----- -- -----------_--------..-_._...- ------------------ - it T --------------- _._._ r final Inspection by: --- ....... --.Date --- Z_ra?-. ............. Eli 13 24 1-68 Hev 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M