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Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) - FOR DEPARTMENT USE ONLY Signed By (If other than owner) Owner Title VOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No, 70 --// Date Issued 27-2(3 This Permit Expires 1 Year From Date Issued JOB ADDRESS/LOCATION 24/-50 01' di - CENSUS TRACT Owner's Name "--eb--Y-)..-4-4go--) t.Phone Address A. 3 Contractor's Name Installation will serve: Number of living units: 1 Number of bedrooms Garbage Grinder Lot Size ; Water Supply: Public.System and name Private i Character of soil to a depth of 3 feet: Sand fl /Silt 0 Clay 0) Peat 0 Sandy Loam :E1 Clay Loam.[] i / Hardpan Adobe'[] Fill Material If yes:Type - , . (Plot plan, showing size of lot, location of system in relation to wells, building, etc. must be placed on reverse side.) - -, NEW INSTALLATION: (No septic tank or seepage pit permitted if Public sewer is available within 200 feet,) . I N PACKAGE TREATMENT 1 1 SEPTIC TANK I 1 i , Size :,,'-c-• , e• Liquid Depth ,_..- . N' Capacity Type Material •No. Compartments Le --. Distance to nearest: 'Well Foundation Prop. Line . - . . LEACHING LINE [ 1 No. of Lines Length of each line 1 Total Length C ..,-.0 'D' Box .. -Type Filter Material Depth Filter . .-. • .. _Material ) Distance to_ea-est Well Foundation P roperty Line V - ......-•• SEEPAGE PIT [ 1 . Depth Diameter Number Rock Filled Yes 0 No Water TablelDepth - . Rock Size , , Distance to nearest: Well Foundation Prop. Line Date 1 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: S L/L 4 1 City .License # igg3 Residence r partment House 0 Commercial 0Traller Court 1 4r i Motel 0 Other . Phone ci REPAIR/ADDITION (Prey. Sanitation .Permit # — — 9e- (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: "1 certify that s a performance of the work for which this permit is issued, I shall not employ any person in such manner as to become u t to Workman's Co sation laws of California." APPLICATION ACCEPTED B BUILDING PERMIT ISSUED DATE ADDITIONAL COMMENTS Final Inspection by: Date :-7--7 SAN JOAQUIN LOCAL HEALTH DISTRICT a E. H. 9 1-68 Rev. 5M DATE P