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FOR OFFICE USE- 411 93 ' APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No., a Date Issued e;?-1.6. 70 This Permit Expires ] Year From Date Issued Application is hereby made to the San JoaquinLocalHealth 1 riot �,prp permit to construct and install the work herein described. This application is mad it i a FPe No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION .R'wx... .__ �,li� �.�� y .......CENSUS TRACT ...__.----- ...............Name e0r ......l�.t�C/ 1 ...../f? Phone �jtU-- r .ne...............................•----- Address Cit ...----•- .......... Contractor Name- ......s ��'_..• <'------•••-- --- License# .,� � Phone Installation Installation will serve: Residence 5 J Apartment House Commercial[]Trailer Co Motel ❑Other--------- :........ I. (" - Number of living units:... ......:: NumIber of bedrooms _. -•.-.Garbage Grinder .IVO.. Lot Size ..3.9 .3._••-;_ } .............. Water Supply: Public System and name ................. •_..-_ .----- ' ---_- .---.---- ---------Private Character of soil too depth of 3 feet! Sand'[] Silt❑ Clay i. I y ❑ Peat❑ Sandy Loam ❑ Clay.Loam:❑ Hardpan,• Adobe ❑ Fill Material s...... .... 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 pUbl cc sewer available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANKA+j Size.__ ._ �( f!-•-.... . `:� ` Capacity Liquid Depth _4!f_.... _ ---- YPe � Materiel�W�! o. Compartments ._ ._.- Distance tonearest: Well ...,.5'��_ __________________Foundation _Z...............R Prop. line "-=-----•-•-•. i LEACHING LINA No. of Lines ..._.....__ T6fdl°::length O. __ ' Length of each line_.1_.��1_.� 'D' Box'�.,1'.�._ T ::a.. I Type Filter Material /E'O_.C��_.._Depth Filter�:,Materiai=: ... _ _ ��: Distance to nearest: Well ......... Foundation ____ .......... Property line ,3`..`-_,.___•_•. " „cEPAGE PIT .. De th ... lS ._._. Diameter _; Number - I �` Filled YeS� NO II% Water Table Depth _.C� .. , �,�,/,rG/ { llr. --•--•-: ock Si l Distance to nearest: Well ....tr1.Q� .......................Foundation .1a__`, ..... Prop,. Line . �< ..+i .......s!..... REPAIR/ADDITION(Prev. Sanitation Permit�# .........__. 'S f .....•-•--....••---........•---- Date ...............• I } Septic Tank (Specify Requirements) ..................... r ......._..._...................................... -•-------•--•---•- Disposal Field (Specify Requirements) ___________________________________ -••- ... ' .................................................. if ---------------______._-________-..._._..__.. R ............................................................•-......._._..:.---__-__._._........_.................. E -----------------I...._..•.___...__+F.._..._ - __ ,(Draw existing and required addition on'reverse side) x 1 hereby certify That I have prepared this application and that elle work€will be done In acco County Ordinances, State Laws, and Rules and Rrdan e"wlth San Joaquin egulations of the San Joaquin local Health District. Neste 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 subject to Workman's Compensation laws of California." " ' f Signed ..............•- - -_----- Owner =4 By .......... . ... . :_..._ ;f .................................- -•-•-•....... Title ....._...�_ i, (If of than owned _ 'r,ii.,,�� - . ................................................. F ., FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. .. ............... DATE i '7a. BUILDING PERMIT ISSUED _______________!_..._.. . ADDITIONAL COMMENTS --•----••' .........._. .. DATE ................ u ................................•---•---..._.................J..----•-..............:.... ................................. ............................................ ----------•---•-•--- --•---------••---••------•---•----••----•----- ._......-•----•. .... -----------� .................................. ..... .-•------••.••...................••••------•---------•......-••---••--•• ........................•• - ......---•-- --•---- il Inspection by: = • . . -•--•--------------............................................................Date�Q__"..'�.c3.--?.Gl..-- -• -• ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.