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FOP. OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . .y�„.Q•7 (Complete in Triplicate) -7 Dote Issued -.�'� ..1... This Permit Fxplres 1 Year From Date issued ` Application is hereby made to the San Joaquin local Health District for o permit to construct and install the work herein described„This app kation is acl In caom,�lior�t0 wit Ordinance No. S 9 and e s n es and Regulc user r✓ /....CENSUS TRACT _ _ 7- ........... . JOB ADDRESS/ TION a 'ync Owner's No .............. ........... ...�.. ...SS City .. L..!{. ,... Address J..Z. r / hone ....................... ..... (/ - .. . f.`.. �'..�... .....license # ��C�..1........ Contractor's N^me .. ....ceyt Installation will serve: Residence❑Apartment H use❑ Commercial ❑Troller Court 0 Motel ❑Other . .... '"'..................... Number of living units:_ -77.. .. Nimber of bedrooms ...--:..Garbage Grinder lot Size .............. . .Private / f� Water Supply: Public System and name .... ...........................C ...................._... .......... ..... ... . . I . Character of soil to a depth of 3 feet: Sand 0 Silt Q Coy ❑ Peat C] Sandy loom C3 Clay loam ... If es, a ........... ......... .._ Hardpan❑ Adobe ❑ Fill Material ..... Y typo (Not plan, showirg size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse NEW'NSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) ----- PACKAGE TREATMENT SEPTIC TANK[ Size .••.... .. liquid Depth ... ..................... ( � J . .../�... .-... -- . Compartments .. . Capacity ��?._' .� TYFM' (�.�.+:4ke,c% Moterioi.:..... ....... �- Distance to neo;est: Well ....... . :,•••.•..Foundation ...IX.�• Prop. line / line _. .� Total length .... � 54 ---------- LEACHING LINE p) No of lines ...... ...I............ length o each '� „ D' Box . Type Filter Material ... Depth ilter serial ... .. . T Foundation ... �C........... Property line ......rf.......... / Distance to near st: Well .......z.`�L.�•- Diameter � � -� Number .... . . . Rock Filled Yes l� No Q Depth 1. SEEPAGE PIT ;(Y P '•� -•'•-•� �} ........Rock Size -- - !;;2.... . . . Water Table Dopth ...........:%.� /' .......Foundation ....,/. Prop. Line ..... Distance to nearest: Well ..............�UD . .) REPAIR/ADDITION(Prey. Sonitotio,+ Permit 711 ............................... ............. Date ............................ .... Septic Tank (Specify Pe ............................................................. ... S ci R equiremr:ntsl --••••••••-•••••••••• .. .................... ............ Disposal Field (Specify Requirements) ............................................ ....................... .. .............I..... (Draw existing and required addition on reverse side) hat the work will be ne in acce I hereby certify es, StatevLaws Pand Ruliesaandication and Regulations tof the San Joaquin Locale Health Districts. Herne owner ence with San r Joaquin Ordinances, . sed agents signature certifies the following: erson In such manner "I certify that in the performance of the work for which this permit is issued, 1 shall net employ any P as to become subject to Wor 14�� s Com ensatlun laws of Colifomia... ^ ... ................... Owner �.. JIB P Signed �..... ..... . .. . / By .�7 /. .. .... 4. 9........... Title ll'I �Q� .. (If other than owner) FOR DEPARTMENT USE ONLY DAT Ef ............................................................... ..... .....:...................... - . .. ...... APPLICATION ACCEPTED BY . .. .r. >r . . r.....�: DATE .......................................... BUILDING PERMIT ISSUED _........................... .............................................................. ADD1,IONAL COMMENTS ......••.... '.... . ._' r.......................................................:. ... ................... .. :... . !......... ................Date'"........:%Te......... ............. .. Final Inspection by: L .i. ..r....». .�. SAN JOAOUIN LOCAL HEALTH DISTRICT 7/72 3 M E H. 1.3 24 I.•bfi Rev. 5M