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'- FOR OFFICE VSE: APPLICATION ICOR SANITATION PERMIT Permit No.` (Complete In Trlplicate)' :.. This Permit Expires t Year from Date Issued Dane Application is hereby made to the San Joaquin Local.Health District for a permit to construct anw Install the work herein described. This application is made in compliance with County Ordinance No. 649 and existing Rules and Regulations.- JOB egulations:JOB ADDRESS/LOCATION ,_.. -•-----��Q/v...................................CENSUS TRACT .-•-----------•-------•--- Owner's Name ... iQ....... Q/ .......................................................PhoneAddress- ------- r -�....................................................----...................city -•--�.iT._ 1i5i........................----------------- Contractor's Name .._�,f�, 5...�_ ,�, .. J ... .-.L€cense#� �t� - - Phone Installatian will serve: Residence14 Apartment House I] Commercial❑Troller Court 0 Motel ❑Other.------•-•----------------------------....... r . Number of living units:___..f.... Number of bedrooms _.-,....Garbage Grinder .4/0.. Lot Size ...��Q„�!,!_�(�........... Water Supply: Public System and name .................................r....................._..............................................•••..Private ❑. Character of soil to a depth of 3 feet: Sand E] Silt 0 Clay 0 Peat Q Sandy Loam ❑ Clay Loam 0 Hardpan p Adobe IM Fill Material ............ If yes,type............... ............. (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc.-must be placed on reverse side.) NEW INSTALLATION: (No septicf tank or seepage pit .permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size................................................ Liquid Depth.......................... Capacity -------------- _. No. Compartments ______________________ i TYI� --------------=----- Material.._...-•------------ r Distance to nearest: Well ---------•--•.......................Foundation ...................... Prop. Line........ ........ ..--•--. LEACHING LINE [ ] No. of Lines ..---_-----_----- --- Length of each line....................... Tota! Length ................ . D' Box Type Filter M ` � aerial _.Depth Filter Material Distance to nearest: Well .............._------- Foundation ......................... Property Line ........................ SEEPAGE PIT [ ) Depth ---- --•---••------ Diameter ..........:..... Number ............._ ............. Rack Filled Yes. ❑ No (3 Water Table Depth ------------- .....Rock Size .................. Distance to nearest: Well •.....................................:.Foundation -------------------- Prop. line ......................0 5 REPAIR/ADDITION(Prev. Sanitation Permit w4t . Date �- Septic Tan (Specify Requirements) _...._._... Disposal Field (Specify Requirements) --------------------------------------------------------------------.....-.--•-------•-------------------•-•----....-----•---._.----------------------------- (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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local.Heallh;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." Signed ---- ------------------------------ ------ ----••. .........::------ Owner By ----- ! • ._._.... Title ...e ` ..y..� r� Ilf other than o erj I r'� '� f FOR DEPARTMENT USE ONLY � APPLICATION ACCEPTED BY - 7. �- - ADDITIONAL COMMENTS DATE BUILDING PERMIT ISSUED ------- -•--------- ----- �........................... - -- - -- -_s`� ..f_ ._.........._.... .: �.. --- - --•- EH ------------- •-- ----- :. ......... . . . . "ie'.' _ ----•----•----- Fina fnspectia by- � :_..Date ------ z3 2!t 1-613 itev.� SAN JOAQUIN 1.06t HEALTH DISTRICT 8/74 3M