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' FOR OFFICE USE: �•• Lf APPLICATION FOR SANITATION PERMIT a 7 /G7 ... 77 /j�ja .. Permit No..7.... .... � (Complete in Triplicate) •y R,�s L } Date Issued 1..-wT—. Q f� ._..,.. This Permit Expires I 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 Ordinonce No. 549 and existing Rules and Regulations: 't iC' 2 -'- ':, JOB ADDRESS/LO TION .. ... . ...7.......�... .. ....... ........ CCENSUS TRi/C'T Owner's Nome ... +. . C ....5,.,�f..]�... Address ........Y-41-5. ... .. .�.. . ... .. hone .. �+'A _... City ... . .. ............ ..l.Lpf/. ho �u/ ,. ..... license #��S/1 Phone T 7 Contractor*s Name........... ..� - "' Installation will serve: ResidenceX Apartment House Commercial []Trailer Court 0 �. Motel ❑Other .... ............ ..... ...... ... ` Number of living units:.. r..... Number of bedrooms .101..Garbage Grinder . ..... Lot Size .....4 ..... .. . . -•• ?.I Water Supply: Public System and name ......................... ..................—..................................................Private r Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay C Peat❑ Sandy Loam 0 Clay Loam ❑ ' AHardpan Q Adobe Fill Material ............ if yes,type........................... (Plot plan, showing size of lot, location of system in relation to wells, huildings,'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[ 7 Size........................................ . . Liquid Depth ......................... . ( , ._.......... No. Compartments ...................... ........... ... YPe ........ Material......... Ca act ty .... ! - Distance to nearest: Well .Foundation ...................... Prop. Line... I ..._......:....:................. .. ................ 8 LEACHING LINE [ ] No. of Lines .... ..... Length•of each'line......... ..............._. Total Length (� p ............................................ 'D' Box ...... .. Type filter Material ................. ..Re th Filter Material - [ Property Line .................... Distance to nearest: Well ........................ Foundation P rtY SEEPAGE PIT I Depth Diameter Number ........._.:............... Rock Filled Yes O NO L, Water Table Depth ............................................... Distance to nearest: Well ........................................Foundation .............. .. Prop. Line ...................... - REPAIR/ADDITIONIPrev. Sanitation Permit d6 ........................................... Date ..................................) Septic Tank (Specify Requirem^ntsl ....... .. ........ .............�.._................. Disposal Field (Specify Requirements) --- - •- - - ,, "'....... - - } . ..Xz. ........ -> -*...... .... ................. ............................. ...................... ... . ........................................... . _.. .. . ........................ ............._......... . (Draw existin!i cr�.i required addition on reverse sl _e 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. Home owner or Roan- sed agents signature certifies The following: "1 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 . pf u her(tn n wner) 4= _ 1AR DEPARTMENT USE ONLYa_f APPLICATION ACCEPTED BY _. .. . .�I(�L t-- ..... - - - - - DATE BUILDING PERMIT ISSUED ..._ . _. -.__DATE _. ..... .... . ...... ADDITIONAL CGMMENTS _. -- - 1�y\`,dJ_, Final lnspePion by: pateC` - � '- � � •JI" SAN JOP.G'U'N LOCAL HEALTii DISTRICT E. H. 9 1.'68 Rea. 5M