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FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT .............................•----.._........._.._._ P 3 Permit No. ..��_` . . . .•e- ICompleto In Tri Ilcate .......................................:�----....... _ Date Issued ................V 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 ig iggta with County Ordinance No. 549 and existing Rules and Regulations. J013 ADDRESS/LOCATION ...... - ? - ••-✓f'xT....i .._...... .....CENSUS TRACT .......................... Owner's Name ._.qJ I ... 1�1f� ._ .... ......................................Phone -'..�. Address L ._ r ----.ExL._�''[. ... __ C E .. .S.- -..City .. .......----.......------- Contractor's Nome .0ZS-0-Al---_.1 1kG�11. l�?. ...............License ,- 7.`2... Phone --Z'97n. 7 •� Installation will serve: Residence Apartment House Commercial❑Trailer Court ❑ Motel❑Other......--••--•...:.....................•--•-- Number of living units:...... Number of bedrooms .......Garbage Grinder V-16-- Lot Size .Ac- ------------------ Water Supply: Public System and name --------- .................................. ........... .......----••---•- ......Private . Character of soil to a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loom Jff Hardpan ❑ Adobe-❑ Fill Moterial ............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 is available within 200 feet) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size.........I.��Tl- ---_- L.._•---•-- Liquid Depth%rA-- .°in......- v Capacity J-2610--- 64 T P �i Type _�--C_.,C�t�3`Material----.._..---•-------•- No. Compartments .�.. ............ Distance to nearest. Well ..../619.. .. ... Foundation .10-41------ Prop. Line ./A'7-42. .. .. --`- LEACHING LINE [ ] No. of Lines ... ,................ Length of Pich line...... 0-_------------ Total Length -----1lo-- V Box ....Z_.... Type Filter Material _/ .,.&tkDepth .Filter Material .... _N------•---------------- Distance to nearest: Well ---- Foundation ---O-X...*FT.. Property Line ....t757 SEEPAGE PIT [ ) Depth ...Z-9 ....... Diameter"t14e1Q!K4lumber ...- —----------------- Rock Filled Yes No - P: 2.......:...... Water Table Depth ................................................Rock Size ...... Distance to nearest: Well /.-Wo ....Foundation _T007.. Prop. Line igPAIR/ADDITION(Prev. Sanitation Permit# -----------................................. Date ................-^............... } �l Septic Tank (Specify Requirements) ..... ........ ...._................. Disposal Field (Specify Requirements[ ----------------•----••--------------------------------- -------•- ------------------._...-........ ------------------•------ ----------------- ---•------ � ----------------• - . ........................I---------------------- ---------------------------------------------................................... ............................ ------ ---------•. ................ (Draw existing and required addition on reverse side[ I hereby certify that 1 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 Hoal&.District. Norte 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 Compen ation laws of California.., Signed -. ........................ Owner By ----- .............. ---- ---- -- ..X. .........-------------- Title ------ -� -- - - ......--._................. (I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -� ----- • -- --- : ....-----... _ :..„._..................•......---- . DATE BUILDING PERMIT ISSUED ----------- --- _._.....__... DATE _...._.. ................................... ADDITIONAL COMMENTS ............. ------------------------------ - -•--- - ------ ----------------------------------------•---••---- -------------- f Pira! Inspection by: ... .......... Date _.....�.....I�.--- -.--------_ EH 13 2h 1-68 • 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71 3 /