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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...76 _//j (Complete in Triplicate) .................. 1:.. m This Per :r Expires 1 Year From Date luauod Date Issued Appliration is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein t described. This application is made in compliance with County Ordinance No. 349 and existing Rules and Regulations: 4 7 �� CENSUS TRACT JOB ADDRESS/LOCATIC>/N /1 /��. . . �.:. �`-�'�•t�� Owner's Name G. ...vim--- � .../ .. ... . .v... . f .Phone Address ...........city c..... ... ... .:. ...............7 Contractor's Name � �'.::.- /=7 C . .. 2"t.'... ..................License �.i.�'.i.�:!.:. Phone..? ....��..r�..�.. C� a Installation will serve: Residence Apartment House fl Commercial ❑Trailer Court D Number of Mogi ❑Other ..-.. Nvm living units: . Number of bedrooms .. .....Garbage Grinder Lot Size ! S l - �j......•.. Water Supply: Public System and name . ..._... ...................... ... .... . ' .......... ................. .......................Private Character of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam Q Hardpan ❑ Adobe ❑ Fill Material .. . If yes,type .. _. .. ... ......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer isovailable within 200 feet,) PACKAGE TREATMENT ( ) SEPTIC TANK i ) Size........... ............ _. . "Liquid Depth yCapacity Type . ... Material.. ._ No. Compartments 2F Foundation _ Prop. Line ....... Distance to nearest: Well _.. Total Length .. r LEACHING LINE ( J No. of Lines Length of each line g L i 'D' Box Type Filter Material ....................Depth Filter Material .. k Distance to nearest: Well - ....... Foundation _ ...,. Property Line SEEPAGE PIT O Depth _ Diameter Number _ Rock Filled Yes ❑ No Q Water Table Depth ... .... .. .... ........Rock Size ... . ...........I........ ....., Pro Line ........ ....... Distance to nearest: Well . .. .. ....... ........Foundation p., REPAIR/ADDITION(Prev. Sanitation Permit# ........ Date _...................... ... ..... ) Septic Tank (Specify Requirements) ....' '- Disposol Field (Specify Requirements), :.....7D... -•••• • -^' .. ........ __ . _ (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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome owner or liun. 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 subiect to Workman's Compensation laws of California." Signed . . __.. ........ _.... . ....... Owner _.. L Title �jL By (If other than owner) FOR DEPARTMENT USE ONLY -: .,�.-..., .-..... DATE . ... ... . .. ........ APPLICATION ACCEPTED BY .DATE . _ _. __ ...... BUILDING PERMIT ISSUED - ADDITIONAL COMMEN .0 ................ AAa� .. . . Date ... .... ... ............ _. Final Inspection by: SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723 M E;H.13 24 1-'68 Rev. 5M .:~ Nr F y ...i , :., �, ..-r ,:.,i L�. ��....?3•}..'Q;.4. Y.�A.�j1..tvrxi�l}.d.n��t•-l•1 7r:1��.M f-d�..k's`.-M i r�Yl�'.@ u'r},S b:w:�L'f..�{�L d�i.L�: n.JP^]'V'-N��:s.. .. g�r� 4 w �� .�. .,, l- � rte• ' .. .. .• ., ';:'h�, .�i '"4 p1V. �i l