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!"OR OFFICE USE: , ,. �' ft APPLICATION FOR SANITATION PERMIT „ z y:..�....L-...;.-�r---- fat' lCompleto in Triplicate) Permit No. ._.----_-• ....................................... S Date Issued 7S -- ` This Permit Expires t 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 Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSAOCATION .. i.�Jl.�i_ !;T?C� �E ..jT.....--_.._!Z770.,_ .Y................... CENSUS TRACT , Owner's Name P� �---•...............................:.....................Phone 1k:ln................... Address ... ' z ............ ...........11 City ....................................................... Contractor's Name -- 5�?gtZZZ r, .:_...... Litaense # 'S4 , ` �� Phone � `.AWP 7 installation will serve: Residence Apartment House 0 Commercial OTraller Court0 Motel ❑Other................•........9:............... Number of living units:....!------ Number of bedrooms ....V..Garba a Grinder ............ Lot Size r......... ._a ...�- Water Supply: Public System and name � ...Private ❑ ' Charocter of soil to a depth of 3 feet: Sand o Silt.['] Clay EY Peat❑ Sandy Loam Q Clay Loam Hardpan Q Adobe 0 Fill M6terlal ............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 .................... ` ! Capacity ----------_------- Type --••-•• ------------ Material...................... No. Compartments .....................� Distance to nearest: Well ...................................Foundation ...................... Prop. Line ......... .--- ............................ V Box ............ Type filter Material __--h_....4..Depth Filter Material ...........................................� ey s Distance to nearest Well ..._.....r-----------:1Foundation ........................ Property Line ................. ....._. i6.4 SEEPAGE PIT [ 3 Depth -----------------=--•Diametera�-�_---•_-. . Number ----•-•---......---------_-- Rack Filled Yes 0 No Water Table Depth -------_--------_-------Rock Size ......... ...................... � Distance to nearest: Well ------------..................:�n....Foundotion .................... Prop. Line ......................f- REPAIR/ADDITION(Prev. Sanitation Permit# .....................................#:. Date°.__...----- } Septic Tank (Specify Requirements) .....---.'...---•---------•----- ....................... _... Disposal Field (Specify Requirements)�'-- - - _---- - --r...._..../..-. o- .......1.49-.-..T -------------------------------•--•-----._...:---------------•--...--••---••------ •------- ------------------ ----- ..4 ....GQ tc r .................------------------------------------------------------------------------................... pe. r :.. (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 Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the :San Joaquin Local Health:District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any persons in such manner as to become sub( o Workman's Compensation laws of California." Signed �DA fp BY _._ --------------- - Title (If other than owner) FOR DiPARTMENT klSE ONLY DATE APPLICATION ACCEPTED BY �.., ._..._ BUILDING PERMIT ISSUED _ ... , E :_. ADDITf N CO TS Uk- -- ................... --- -------- `--- --------------- ... ________________________________________________________• -_----___._____ __.______-F___..__.-__..______._____..__..-.,.._.._..-......-_.__..... - -- y�r Final Inspection by: - Date .. _._. 5 - -----•---- EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3