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FOR OFFICE .... APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Triplicate) 9 �� __..... :....,:.._.__.. ..� Date Issued 5:7............: ------------- _- 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 in compliance with County Ordinance No. 544 and existing Rules and Regulations. JOB ADDRESS/LOCATION .,3t�.6PDO........:.....:..r3r,. .5./0.r.-' �1-._.../ ..............CENSUS TRACT ._..................- . Owner's Name ......,�� rr. , -h...... ..a. -•.... ------ .....Phone y Addiess ? -( -....... ^e ./ll&r�.._. . ..... city _ - ....._... Contractor's Name �y+ �-•= � /:.� ------ ...............................License #al.� .��--- phone __ Installation will serve: Residence;ZAportment House❑ Commercial ❑Trailer Court ❑ Motel n Other -- ........ •--•..............•----- �,) Number of living units:- /_.... Number of bedrooms _._....Garbage Grinder9.. tot Size .......•.......... Water Supply: Public System and name ........... .............. :.. a..... ..........................Private, ' Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam i-fa�dpan� Adobe ❑ Fill Material _._......_ 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 I I SEPTIC TANK . '"` ' Size.-�IjFf..?X,.....-_.. Liquid Depth _x.19... ...•.•....•• " /lv��. . T e ._ Moterial�lp6f-`----- No. Compartments .. .............. 0 Capacity . Yp � . w � v Distance to nearest: Well . ./ .'--------- --------Found`ion e . tine /`f0 ��...-----.... LEACHING LINE No, of Lines .-. Length of each�line.� �.:....:_.... Total Length .....:...• @ ' rYP Depth F� 'f 'D' Box/ DWS c.�F , Type Filter Materiae De th Filter tMoteriol �V'F . .........................:....... � er 3 , �..... li 1 Distance to nearest: Well _10e------------- Foundation .. �J'.___r..._..---. Property Line -�0--.-_-- . SEEI;A� �QDepth `10. ...._...--,Diameter f�/O`�:`Number . ....�_�fi....._. . Rock'Filled Yes, No ❑ . ' s l Water Table Depth .JE aJ'.....__`..__.....................Rock Size/ - `---•-.--------. '• 1 !� Distance to nearest-Well ./'Fig _..._; : -!!_...Foundation _ ®_. ..__...a'Prop. Line . ...... REPAIR/ADDITION(Prev. Sanitation P•.ermit'# ------------------------ ----------- Date k .— -----,-.-.------- Septic Tank (Specify Requirements).- ---.. 1 'f v1 ' Disposal Field (Specify Requirements) . . ---- ------•---- --.----. .._.. ------._....... ...._...... Y S T ....................................................'-C........ ........ ----------.----------------------._..._____.._......._..._............. _._..._........_...... ._..... . ...............................................<.............._...-...i_.....................................--------.;---------_-......-------...-..----- --.. .......__....... _.r�. ......._-.._.. (Draw exiisting and required addition on reverse side) i= y I hereby certify that I have prepared this application and that the work will be done in accordance wiihSbn_ Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- 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." Signed ............ . . .. ............. . Owner ----------------------------- - By ._ _ _ -- ---------•--- Title . _ 6�f` .,............. ` =y-...-.---... (if o than owner Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------•---..... .._._............................. DATEV......... ...... BUILDINGPERMIT ISSUED ---------- ------- o ...... .......... --...... ----------------- ........_.... .........._.DATE . :":?....-._._-. .................. ADDITIONALCOMMENTS ...... ----------- -----•---------- r�_......_____-.._.. ........--.....---........--- ... ....•--•-._....-_.............•--............--•--- ...... ---------------- __............................................ ....................... ............... ----------------_ -------------------------- f� ( Final inspection by: .. ---.--------------------_---------------------- ...-- --.--••----•-----------Date SAN JOAQUIN LOCAL HEALTH DISTRICT F H 13 24 t.-'aa Qev- 5M _ _ 7/72 3 X