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Xp OFF.IC USE: 1%. �APPLICATION FOR SANITATION PERMIT...................... ........ Permit No: _........ (Complete in Triplicate) ..........-.................---------------------y.... :....................••----.......---•- _.••.�j°-- This Permit Expires 1 Year From Date Issued Date issued ._.:� .74 ti Application is herebv made to the San Joaquin Local Health District for a permit to Co.s uct n 1�s l Njrz- reindescribed. This application is made in compliance with County Ordinance No. 5 d es R is nd JOB ADDRESS/LOCATION ...�. _d�-.__ 1141PA r--•-- -------- - ..CENSUS TRACT _------------------------ ------------------_---------- ---•-•---•-------------- . �� ,7//�•--,�� /ho ne.Owner's Name ................ .: ty z- --------- ......G License #Address _ Contractor's Name Installation will serve: Residence Apartment House] Commercial o. Traile•r Court C1 . Motel ❑Other.---•---------- ----------------__-------- Number of living units:.... Number of bedrooms ---Garbage Grinder /��- Lot Size -.._.__.._. Water Supply: Public System and name ------------------ ---••--•------••--------------•-----•----- ----------------........:.-......................Private i p t. Sand E] Silt f-] Clay E] Peat❑ Sandy Loam -E] Clay-Loam�' • Character of soil to a c.e th of fee Hardpan ❑ Adobe 1] Fill Material ............ If yes,type..._...................... {P("ot plan, showing size of lot, location of system in relation to-wells, buildings, etc. must be placed,on reverse side.) I NEW INSTALLATION: [No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size----------------------------------------------.. Liquid Depth ......._ ....... � Capacity j-------------- Type --- ••--------- Material....................... No. Compartments ............ ....... 1 Distance to nearest: Well ____________________________________Foundation ..__.--.-.__....._-_.- Prop. Line.--------------_:...... LEACHING LINE [ } No, of Lines ________________________ Length of each line_-....__...._.__--____--_-__ Total Length _---------.................. 'D' Box ............. Type Filter Material ------------------- Depth Filter Material _-................................ .:.....:.. Distance to nearest: Well ------ ----------------- Foundation --.-_.-..-_----_-_--.- Property Line .................... , SEEPAGE PIT [ ] Depth ..... .............. Diameter ._.------.------ Number ------------------- Rock Filled Yes Q No [ Water Table Depth ----•-------•------•................. ......Rock Size ................................. Distance to nearest: Well ................................_._.....Foundation Prop. Line ........._...... ..... REPAIR/ADDITION(Prev, Sanitation Permit# ............................................ Date .........-------.................. } i t Septic Tank ISpecy Requirements) nts) ------ -------•--- --•---------------:--•----------- --•-•-- - - �._...... .-•--------- 141, Disposal Field iyfeRe u r f i# I'lDraw existing and required addition on reverse side] 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 Health 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 sublect to Workman's Compensation laws of California.". t Signed Owner CIJi�L�I By ............ j. l' ------•--------------------------------- Title .. _----------------------------- f of`er tFian ownerl FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED 6Y : .�ic .....1 -h.yf.0_eJ----=--•-------------------------------••--------. - 'DATE .. ..r.C�2 ..........jd.•--.. BUILDINGPERMIT ISSUED ..................... ---••- --------- ----------------------------------------------- -.-.----.DATE ....... ....................... ! ADDITIONAL COI:".,+.\ENTS _...._._...-I------------------------•----....--,----.----------. ....--.---.....-----------...-----....-.;...._.....----•--•------•----•------------.....--- .............•--•--- .....-- --......------.--•--------------•----•-- - •-•--•-- ........I........................ ........................................................ ---------------------------------------------.•_--------------------- .._.._ ............................... ............... _•_____...-...__. Final Inspection by: .. �..0 ----- ........................=- -_....._ ......_.....Date f .- SAN AQUiN LOCAL HEALTH DISTRICT E. H. 9 1-'68 P,v. 5M i Y