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01 FOR OFFICE USE: `LICATION FOR SANITATION PERMI" Permit No. 71 .-5 - 7- - -- - - ------------ - ------------ --- ---------- - (Complete in Triplicate) .... ------------------- --------------------- Date Issued This Permit Expires 1 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 in1�compliance �]with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ _ .. S.? --- --- !'-/ - ` --- -----CENSUS TRACT Owner's Name r- � = •tel one . Address - 4-'�� 'L - '�---- 1F� --.J�- -----. City _ fit' f'rG�=rJ_. Contractor's Name -- ------ _ rd K� _...----.License # J_RY3,, .P<__ Phone .............................. Installation will serve: Resident Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------- ------ Number of living units:------ Number of bedrooms ------3---Garbage Grinder ------------ Lot Size ------------------------------- ------------ Water Supply: Public System and name __________.__.. _-------.------------ - Private (� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 seeppge pit permitted if public sewer is available within 200 feet,) I P P I ', i 1, PACKAGE TREATMENT [ ] SEPTIC TANK [ Size.s___x_).D..__.1�(_.-. __._�-._--_-- Liquid Depth . .... ............. Capacity .J L10 Q ----- Type &14A�__ Material__t l�'�� _ No. Compartments ....s�........... Distance to nearest: Well . ---------- _________Foundation _--------/.V---`---- Prop. Line ____ ....... C LEACHING LINE [ No. of Lines ------ .. Length of each lineTotal Length ----- .Pn_._._._.__ � 'D' Box _� ___ Type Filter Material ____.._ _ '__Depth Filter Material _..__.�_�_............................... r a � Distance t nearest: Well _---_-E'o_�.___.__ Foundation -_.._._1�'.__-____ Property Line .....s............... SEEPAGE PIT [qx Depth __ G ._�.. Diameter _3.3...... Number __- -----5A_ Rock Filled Yes Z--"/ No C] Water Table Depth0---•--_---------------Rock Size ---- -7---- --------------- Distance c Distance to nearest: Well ..... ....... .��'----- _.___.___-.Foundation _(.0_1---------._ Prop. Line ........... REPAIR/ADDITION(Prev. Sanitation Permit# ------- ----__-----------__- Date _________________________________) Septic Tank (Specify Requirements) -- ---------- ------------------- ----- ----- -- --------------------- ------------- -------------------_ ------------------ Disposal Field (Specify Requirements) ------ ------------------------•---------- - ----------- --- ------ ---------------- - - - --------------------- ----------- - ...-- ------ -- -- ---- -- --- -- ------ - ----------------------------------------- --- ------------------------ -- ----- ---------- ----------------•----------- - _ - - ------------- --------- - ----- --- ------ ------------------ ------- -- - ----- -- --- ----- ---- ----- (Draw existing and required addition on reverse side) I 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: J "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 subject to Workman's Compensation laws of California." Signed .. .- ;� - Owner BY -... _.. . G - Title ._. .... _ r -- - - ------ ------------ (If other than owner) FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY �� 3 o O ��-:_--- - - - --- -- - - - --- -. DATE �- �'....- BUILDING PERMIT ISSUED _ -- ---- - ---------- -- --- - - --- --.-.DATE . ------------------ - -----.._.. ADDITIONAL COMMENTS -. . -- - ----- -- -- -- --- -- ----- ---- ------- ------ -------------------- -- -------- -- __- ------ ---------- ------- ------------------------------ --------------- --- ------- ------ -- - -------------- ------- - -I--- ------- --------------- -------------------- --------- ------ -------------- ............. ---_------------ - - ------------ - - - -- - Final Inspection by: �cilf } - I 4... . -- -- Date/.. i- ` ---6 SAN JOAQUIN LOCAL HEALTH DISTRICT F 14 Q 1-'64 Rev. 5M