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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT IV (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued _ Date Issued.71,179.... Application is hereby mode 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 9rdinance No. 549 and existing Rules and Regulations: J08 ADDRESS/LOCATION ./ -_(�11Q�-., .-- c_.. _-J .............._..CENSUS TRACT ... . ... Owner's Name - Z / _ _ _ o - Address ..... f0 ......._....?'Cc..i-`---- - --- _. ity ------•-..............-........................................... Contractor's Name -...-------- --.....4+.__ ...-'-------.License#1 .. {/.... Phone Installation will serve: Residence XApartment House Commercial 0, Trailer Court ] Motel Q Other........ •1. Number of living units:......... Number of bedrooms .._*._..Garbage Grind at, _' ,Lot Size .130. 17D................. Water Supply: Public System and name .... -------..................._. 'I ......... .._........_.......-... _.._....... Private Character of soil to a depth of 3 feet: .�Sand Slit C1 Clay ff- Peat❑ SandyV Loam fl CloLoam..0 Hbrdptieen:flti ,Adobe` Fi11.Material ------- ___,1fyes, type..... ........ ._.....-_-- 1 (Plot plan, showing size of lot,location of systernonne,relation to wells;stiuildings; etc.-must-be-placed.on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewe(is available within 200 feett PACKAGE TREATMENT I ) SEPTIC TANK' '�c% Liquid Depth ................... ..... t j Size_y,t. ..Y:. .................._..... Capacity A------------------- Type ...... .�..Wla4rial..f..... -•-....... No. Compartments .................. � Distance to nearott Well ........ .... ... �* ....Foundation .......... Prop. Line t {r ' LEACHING LINE [ j No. of Lines ........................ Lengt f each{line........-......._........... Total Length ,_.................:........ �[ I 'D' Box _.. ......... Type FilterMater-al__!....._....L _.Depth Filter Material .......---------.............___..__---_-. 1 Distance to nearest: Well .......... -_.--...!. Foundation ....................... Property Line r._...................... SEEPAGE PIT [ ] Depth .................... DiameterQ �.yumber .................... ....T:..Rock.Eilled Water Table Depth ! ......Rock Size ....... ....�_. t Distance to nearest: WeN ._... —4.:.— :::__.::.FounddNon ....__.!....._..... Prop. Line ............. REPAIR/ADDITION(Prev. Sanitation Permit# ........_! .�.�.,. _... Date r ) Septic Tank (Specify Requirements) __..... DsGt;t'_-> .. _� ._:. .. it!. Disposal Field (Specify Requirements) ....y------. - .-- n- .t,--- -"---....I . [_ .. .._ .._-...v...._...... ...............-"•--'..........._.........•'----'---_-.-.-..K.�:Sa�'-....._Z-:. .._.. _.e�� ..... -- - -- --- - --- ------ ...._ -------------------------------------------------- --------- - nom-- -...-- (Draw existing and required addition on reverse side) 1 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 Distiikt�Aome owner or licen- o sed agents signature certifies the following: �' "I certify that in the performance ofahe work for which thisipermit is issued, 1 shall not employ any person in such manner as to become subject to Workmp's,CompensaKon laws of Gi�•alifornia.^ t t 1 1 Signed . t ------ } Owner ..:.............. .... ....... . _ By ......... ' ..r..----'.r - — Title ::-�.."��7_ (If oth an owner) O EPART ENT USE ONLY APPLICATION ACCEPTED BY----- __ . . .-. _ . _-- �-_........... DATE ...... y6 BUILDING PERMIT ISSUED. - .. --- --- ....... .. t .. r..........................._DATE ...__------------....................... I ADDITIONAL COMMENTS ......... T -_._._ "ytr _ s!_.,;_}, �";� -- .. ..a _wr.a. ..1 1 .................. ... ...... .. .. .... `. ................. _ .. ...................... ............._ _____ ___ ___ ________.........______ _ __ ........ . ..................... ... py t .................................... ......... ..... ..i ..... Final Inspection by: ............ ... . . - - -- - - ----...I------.......---...-•----•----...._---.......Date .. .-.. ..- .� ......... IN L6:AL HEALTH DISTRICT s E.H. 9 1-'68 Rev. M