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FOR OFFICE USE: �6-- ------------------------- APPLICATION ,FOlk"SANITATION PERMIT .. , � # Permit No.- (Complete.In Triplicate) ; r.rr: 3q- „� 4`4l',t'q �"..'I Date Issued��,Z'=�% ��-__--- This Perrl it Exp4ls l Year From Date Issued r r � # � Ap�4iiLation 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 CounA'y Ordinance No..549..an d existing Rules and Regulations: / -- ----._CENSUS TRACT --------!7 ADDRESS/LOCATION .---"7 -1 - -------- --- ---"C---- Phone 7. Ow er's Name " Phone �J T ------------ - -------------------- . Address --------------------- I� _ �-------- -------- _ I �� ) Phone -19 Contractor's Name --------- -. icense # --------- i 5 1{ t Installation will serve. Residence Apartment House❑ ,Co mereiul t❑trailer Court ❑ X � S jL Mote! ❑Other -------- - - � ------ z..9 r- �g. F_________ Number of bedrooms _.__-_______Garbage Grinder __________- Lot Size _______—------------------------ W x-�SS-----------•••- Number of livin units: -, � ---------------�--------••-------------------•-----Private [] Water Supply: Pulblic System and name ---_______------------------------_------ ,;;�---- Character of soil t a depth of 3 feet Sand ❑ Sift❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam [) : Hardpan ❑ AdobeFill Materiol If yes,type --- ----------------------- A I ,h` -I size 66 l ott ` ttion of s stem in relation to wells, buildings, etc. must be placed, on reverse side.) � (Plot plan, showing sFze o�F�l�ot�ca y _ _ ANEW INSTALLATION: (INo p,� t,c3ank or seepage pit permitted if public ewe is a}:di,lable Within 200 feet,) i� 4 l G� PACKAGE TREATMENT [h} ( PTIC,TANK z [ ,!____. _:_s -1--------- --------- Liquid Depth _"___:` ------•-- ,E� C opacity /A00-____-- Type 91-7 Material_"" .��- No.rCompartments +.---- ---- 14 1 Distance to nearest- Well _____/!�___________ __________ Foundatio� ti* Prop. Line ._ -U--- Length of ach line----- ----------- )Total Length _ -�~----------- EACHING LINE [ ] k o. of Line ; P 'D' Box .__ --_ Type Filter Material ----Depth Filter Material ______l_1?------...:--------............ I � � r r Distance to nearest: Well __/_�________-___ Foundation -____LQ______ ---- Property Line ___ �-------------- �' SEEPAGE PIT [ ] Depth 5�- ------- Diameter _ -~ Ar `Number ----------3-_-_----.------ Rock Fulled Yes:V No Water Table Depth ` •-----Rock Size -��y. w hFoundation V.0 *I--- Prop. Line _;___.__ __...•.------ l istance to Iearest.. Well -------/t0-------------• ----- REPAIR/ADDITION,(Prev.Sanitation Permit# -------------------------------- -- - - Date _____._� tea__ --i Tank (S ecif R # T P Y equirements) -•------ ------- -- -- -----'--------� - ------� ---------...__�._----- �--------------------- Septic Field (Specify Requirements) ------•--- ----------------------- Disposal ---;----------------------------------------- � lu.t -A.t --------------------------- -------------------` . -------------------- :'"`: _ ----------------------------------, =,, r . _ ' "� `-------------------- - -- ----------- --- ------ -- - -- - _ �t�(Draw:existing"arid required addition—on—reverse—side),:0�- application and,rthar the will be done in accordance with San Joaquin Ihereby certify that l hove prepdreilthis County Ordinances, State Laws, and Rules and Regulations offLhe-Sant,Joaquin Local Health District. Home owner or licen- sed agents signature certifies,,the following: s "I certify that in the performance' Rhe work for which this permit-isciss'ued, [ shall n t employ any person In:;such manner as to become sublect to Workmate s`Compensati.on laws of California." (` ` Signed ---------- -- ---- --- --- -- '------ -- ---- --- --- Owner ) `t Tittle ` --- t _ --------------- ------------ If other th ... Y ---------------------- -----------h _. y caner)` FOR DEPARTMENT USE ONLY 3 APPLICATION ACCEPTED BY --1---` <-a__ f�- d- ' `` = ''$DATE S. i2 - jQ ` DATE `- -- = =' BUILDING PERMIT ISSUED ----------------------------------------------------------------------- ------------------------- DMMENTS ------------------ --------------------------------- ------------- -------- ---------------------------------------------------------`------ ----------- --- -- - ----------- ---------- ------ ---------- -� 4t - --- ------------ =- --- - ---------- 4D, Y��e � F - ---------- Final Final Ins ection Dat -------- SAN JOAQUfN" OAXAE"ALTH - DISTRICT E. H. 9 1-'68 Rev. 5M Alli