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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT in Triplicate) Permit No. ICnmtete p ?' L.........................�. �� p ....................... ...........................�.. This Permit Expires 1 Year From Date Issued Date Issued .16 Application is hereby modelto 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. 544 and existing Rules and Regulations: �l JOB ADDRESS/LOCATIO :,�.. -.....d L.." ............. .........CENSUS TRACT ...-•-----------.. .... . Owner's Nam .... a' ------f/ .. -- . . • . ._....... .. .- ......... ..-... 1 �J .-----•--- ................ Address � M . •• ---- City- ----------------..........._._............... . Contractor's Name � j <� -... 'r '_.d4., u __. e1�.�...e License t Instal latiori!w il I serve: Residence VApartment House-0 Commercial ❑Trailer Court ,❑ Motel ❑Other , ........ .......... ---------------- Number of'living units:....A-. Number of bedrooms .��._..Garb e Grinder .7-67-7.. Lot Size ..w C/ -......._...... Water Supply: Public System and name ---------------------- --•-•- ...--- .........----.......Private Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ ii I1� Hardpan ❑ Adobe X Fill Material ..._- ----- If yes,type ............... (Plot, plan, showing size of allot, location of system in-relation to wells, buildings, etc. must be placed on reverse side. `. u I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ] SEPTIC TANK.1)( Size. � - qDepth Capacity� /CG + ,TypeA Material.. No. Compartments ....--..-- ........... ! „ Distance to nearest: Well Foundation ... . ...... Prop. tine ._ LEACHING LINE rV No. 'j�o f Lines p>I _ Length of eat line .:...� -.....-- Total Length V_-.P_....-.-. D' Sox ... Type Filter Material �. Filter Material ��..........•...............__...__- ,M . ....-._.-.Depth�o , Distance to nearest: Well ��............... Foundation .-_....._........._ Property Line _.-.. ._.... SEEPAGE PIT Depth .....- Diameter �..--- Number..a�... o'............ Rock Filled Yes;k, No ❑ .. --�.. Wato Table Depth Rock Size .. -.-... ------------ . ----- - Distance to nearest: Well -.-�Q� -- ---------------------Foundation Prop. line REPAIR/ADDITION(Prev. Sane�ation Permit�# -_-.---.--_.........................:`.. Date -......... -- --....--------...-.� ; Septic Tank (Specify Requirements) _ _ i --- .. -4�� - -------- --------------------------------------- Disposal °field (Specify Requirements) ............. ........................ w ............ .__................... .........................................._._.-.------- ............. .. ......................... 1 (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work wili be done in accordance with San Joaquin 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: s "l 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." 4 Signed . I� Owner ...................-- - - --- By h Title i jj (if other than owner# (/ I, FOR DEPARTMENT USE 2� ONLY APPLICATION ACCEPTED BY .. �e - DATEC BUILDING PERMIT ISSUED ... ! ......... . - I ... ......_......DATE .................... •--•-- ADDITIONALCOMMENTS ....:�.„-•----.-•--- --------•----------------- ----•----- --- •.......................-:... ........... . ........................................... �I ................. ........... -------- it .. - .....................................•-------...---••- t !I .-.... ? ---------------------------••. ----.-.....----•---------------. ...... - . Inspection b ' -------------- ----Date ... . .-. /- .----------------- Final -- ii SAN JOAQUIN LOCAL HEALTH ICT 4 __ E. H. 13 24 1-'68 .Rev. 5M _._ 7Y72 3 M 1