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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT �'• (Complete ri licate Permit'No. .7, ................ -- . .,.._. talo Y A . 1 . - ---•-- .. - This Permit Expires 1 year From Doh Issued Date Issued S?S� - Application is hereby made to the San Joaquin Local Health District fora k described. This application iss made in complionc with County Ordinance No 549 and existing Rules tand Reg I 6t�sf8 h JOB A©DRESS/LOCATION Z.9.4 , •e.. w i y ......CENSU f' . .�Per:t��,�... ...��... � s TRACT.................. Owner's Name _._�IQ��..��.1.�• .. --••-•.................................................. Address �..._ :...:................Poe ..... ....E��- Phone .................... .-. city Contractor's .q . .................. -------- I s Name .. .: --.R.12P � - Q-1 4......X.AAlc'i-.-_-License� Installation will serve: - ..•• Phone . ..¢ "✓ Residence Apartment House❑ Commercial❑Troller Court ❑ Motel ❑Other............:.. . units•.... __'._....__.--•---•'_....__.. Number of living - Number of bedrooms Garbage • ------ Grinder Lot Size .-- 1Nater Su �_._.... Supply. Public System and name •---•............................._...._ Private Character of soil to a depth of 3 feet: Sand❑. CIO . ° . Silt❑ Y ❑ Peat❑ Sandy Loam o Clay Loam 4 I Hardpan p ❑ Adobe YO Material ............ If yes,type............... ............ (Plot pian, 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 ` I Size................................................ Liquid Depth ...... �* Capacity •--•••--•--•--••••-- Type Material..--•-----•...._...--• No --•-----•----------- Compartments Distance.to nearest: Well ---------------- _-..--_-.-Foundati ---•---• ...__ Pro LEACHING LINE on .......--•------• p. tine ......................� [ j No. of Lines ........................ Length of each Ilrie._ Total Length......---•..... 'D' Box Type Filter Material - Depth .Filter Materia! --- - Distance to nearest: Well -------- ........... Foundation ... Property Line SEEPAGE ( � E Depth Diameter: ...........-.... Number ............. ......... Rock Filled. Yes ❑ No 0 Water Table Depth ' = . . --• .............. Rock Size Distance to nearest: Well ................ Foundation . •--•................... Pro tine REPAIR/ADDITION(Prev. Sanitation ..... """""" permit# . ' Septic Tank JSpecify(SpecifyRequirements) I � DisposalField (Specify Requirements) ..- ...................---• _�- �._:__.Qs .Y�.------/p 'T � r�e..................... r ------------ ------ ---------- " IDraw existing and required addition' ............ .............. on reverse side) ! 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 MBQIth;Dlstrltt. Hattie owner or liven• sed agents signature certifies the Following: r - -- "I certify that in the performance of the work for"which this permit is issued,I shalt not employ any person in such manner.--. Cis to become subject to Workman's Compensation laws of Californio:'� f Signed _.--Z&''',I-4R.'214,&_*-_& �.,,_ K s� ra..._. 7 iif 0i1*1---------------- Jitlee;�.�� ...... .... ............................... FOR n owner) ;O -- FOR DEPARTMENT 65i"ONLY APPLICATION ACCEPTED BY----- BUILDING PERMIT ISSUED -------- ------- "---.._.__. - DATE . ADDITIONAL COMMENTS--- -- --------•- -..._.--------- -•-•-• -------------------------------------------DATE - .._.::-------•--- ----------•- -------------------------------------------------------- ---.----- ---.._......_,----------•--- ................ Final Inspection by: ..---- -- ---- -- - -- -- . .. EH 13 2h 1-68 13eV. -----. ---- - .............Date .._...._. :_ :.%.... .._. SAN JOAQUIN LOCAL ALTH DISTRICT 8/7h 3M