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F FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1... f.... ,`` Permit No.ZkI-SS S` l (Complete in Triplicate) l Date Issued ......................................................... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with iCounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,..Q.U.LJ,s�!...,�a_,... .lir---• ........_CENSUS TRACT .......... Owner's Name .... ............................................... -------- ......... hone��....._.._3 ._ .,_.....-•-- CL ._O..vi:?� �!J. r City tom`"` Address ......_.. ......... ..... ..• ------•••--•... ..._.._.............--- . ... Contractor's Name ._.__.....iC. .... .._ �` .......•...................License #� � 5�.?...:.. Phone e' A4..>�'��7... Installation will serve: Residence ❑Apartment House, Commercial ❑Trailer Court 0 ` Motel El Ofhe'r: :_ `lr� .➢ ? t_ - --- Number of living units:.... Number of bedrooms ...5.....Garbage Grinder ............ Lot Size ............. ......... Water Supply. Public System and name --------------- ------•- ......................................................................................Private s l Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat[} Sandy Loam ❑ Clay Loam 0 Y Hardpan Adobe [ Fill Material ............ If yes,type ............................ (Piot plan, showing size of lot, location of system in relation to-Wells, bldings, etc. must be placed on reverse.side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) + PACKAGE TREATMENT [ } SEPTIC TANK YNze-..��- �------•-----. --• •- Liquid Depth .. �.�.-r-r-• -----••--- I�'`.�.•• `1 4. Capacity/�v ----••--_. Type _ _ - - --- .._ Materitsl ••------------------ No. Compartments ...:....-........_..__,did Distance to nearest: Well ---.lam...-F.•-----.mak'::::-:Foundation -----/-0----------- Prop. Line .._5---- CIO LINE.-�' CNo—of`Lines _.___ ____.... `_ length :of each line._._.I____Q_........_._ Total Length ...� ............... ISD Box _. ype FiIterAllaterial ..._ i ....De� th Filter Materia) ........ .........................:... __ Distance to nearest:_Well/j0Q.�:f':._.-. Foundation ...._L0 !` =`_ . Property Line ..1 ? .... . .......... SEEPAGE PIT Depth _..-9�.,C-. 1____ D'rQmete'rNumber ...... .......f_.._... Rock Filled Yes JZ No C3 7 Water Table Depth ............. ..-•-••---•-Rock Size ... Distance to nearest: Wel! ----AW.__1'-~• - ,.......Foundation .../Q..f..... Prop. Line . . _._._ . REPAIR/ADDITION(Prev. Sanitation Permit# ....__...................................... Date --•---.-----------...._-..-.......) SepticTank (Specify Requirements) ..............................................................•---....::......:......--•---•--•------------......._......_...----•-•-----•. Disposal .Field (Specify Requirements) ......................... ......------••---••--•--------------------•••-•---......-•-•----------•---..............: .............. --------------------------------------------------------------•---......---------------------------- a, =R_(praw existing andrequired addition on reverse side) I I hereby certify that I have prepared this applicdtion and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and 'Regulations of the Son Joaquin L cal Health District. Home owner or licew sed agents signature certifies the following: "I certify that in the performance of the work for which this perm t is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of'C�-dllfornia." Signed ...................... .......... ... ........ ..............................................._ Owner ....--- ••..---•- •• -------- •-------------•••---......----•--•••••--......... Title ...__.. t::..... ......__ ............... ............... Y _ ..... (If t er than owner) : FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..C> .7 ...:............. .... d DATE ,. .""....i�9''. .... BUILDING PERMIT ISSUED ..__..... ..'...:. ....... ........ ..........DATE --•............:........................... ADDITIONAL COMMENTS ...../21. .. r� r;�..- �`1 Y _ ........ ;. . ___--.-•............................................... ..... .....................4__.__..-------.----------------------------------I......._................ ................ _ ....a. --- ._ ............ ... .. -- Final Inspection by: .............Date SAN J QUIN LOCAL HEALTH DISTRICT CO F H 13 241_'AA QAC. 7/72 3 M