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..r•':::... _... ,R_O�F�F�ICyEY_US_E •I� APPLICATION FOR SANITATION PERMIT ...................... I .... ermit. o... .7... ..{Complete In Trlplicatel F` . ... i Date Issued ••-••...............................:........•--•---••---. This Permit Expires t Year From Dato Issued Application is hereby made to the San Joaquin Local Health District for a permit�to�tonstruct and install the work herein described. This application is made In compliance with Cbunty Ordinance No. 549 and:w4tiniaihotow and Regulationst 108 ADDRESS/LOCATI Irl .._.... ...1.... fr.... f t _.... y '�(r-- ENSUS TRACT ....................."..... Owner's Name . ..._. �a .. ............. .. ..Phone ........................... Address .. ._ -�.��.......�'.._ . • • �.L�-- f City Contractor's Name �` t �_• • � �� .•' P---�c?vE��:L�t•�..,dtG!fii�.; �.1C8n5e #cam_ �!.��1.-d. PI'IaR@ ,��_�•.J-�.v7 rl�._ �•- Installation will serve: Residence Apartment House Commercial QTroller Court 0 Motel [ Other----------••---- ..................... i 3 Number of living units:--.!./. Number of b Brooms . Garbo � -Lot Size __.... _ �•t' ,!� ••-•- �-- •-- ge Grinder .•-- Water Supply: Public System and name ---- _-�' ! ..._�.c� _____________________________________________Private (' ` Character of soil to a depth of 3 feet: Sand n Silt Q Gay p Peat❑.,,.Saridy_Loam:_0Clay Loam Q� _ —Hardpan Adobe 0 Fill Material --•- If yes,type ................ ............ {Plot plan, showing size i�of lot, location of system In relation to wells, buildings, etc. must be'placed on reverse side.) NESN.INSTALLATION: (No Septic tank or seepage pit permitted if public sewer is available within 200#eet,) ? D � _PAC.KAGE TREATMENT fi,] SEPTIC TANKXr Sixe__a.�e ---1l1(..•--f-----_-_-- Liquid •../... .:.......... L Co pacit}t/ XMaterial__ _ lX9No. Compartments - --------..._•--• Distance•,to nearest: Well _. • --- Fou d clorC g __. r 1 ._..-- -- op'Line k ]` o. of Lines .. ......:...:..... Length of`pach�l ne D_'�...._.__ Total Length ... . LEACHING LINE � • .� ' Box l " !i D :. T e„F.ilter-f111dferial Depth Filter Material , ............................. Yt� r 'Q.istanceoto nearest: Well ,le-V.... ........ Foundation _?.............. Property Line .. ........ SEEPAGE PITDepth .1pS.-. .. _. Diameter ` ' Nolo �.�` f• ��---------: Number ..,�_.. ' ......._... Rock Filled Yes No " `-Water Table Depth ----`-. .._ .................. Rock Size i... `• , . . ----•---------- { .� Distance to nearest: Well --� f,- ------------Fo ndation .__.`�---- -- Prop. Line ....vs, -••_� q: - s. € REPAIR/ADDITION Wrev. Sanitation Permit# ---:-- ................ `�--::: Date __._,...±........:......... ---_-_) 4 Septic Tank {Specify Requirements} . j ••-_-_......--••--.._._... i i ...... _. .•• -- •--•--------•..... ... i Disposal Field ISpecify'�Requirements) .__....:----------- --- ,. - ..... t..._.. �► i II -- .. r ..._ i. -•----------------- --•------------------- --• --- ± F ...-------•----------;----_. --- --� ---------------•--- --------- - f �--- _"___•_----_-............. . Sar _ _ _ :.__ ........ .....:._ ':..-.._._____..____ ._.:.... ___.___._.._........._. ".� (Draw existing and required addition on reverse side) E I hereby certify that 1 hale 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 Son Joaquin Local;Health District. Home owner or Ikon-Sid agents signature certifies the following: ".I certify that in the performance of the work for which this permit is issued, I shall n'ot employ any person In such manner as to become subject to Workman's Compensation laws of California." r Signed ....----- �... .- • .........:... ...•---•-•--- ---......__ Owner " 4I By � Witte ......._. y ------- -------- (if other than owner) FOR DEPARYAkENT USE ONLY I APPLICATION ACCEPTED "pBY •- - - - Z DING-PERMIT-'ISSGED �._ ^ �- . . - " DATE ...--- = ©AfiE . ADDITIONAL-COMMENTS �'. ------__:i::=- ...... -. ---"-'"--- - - - • •- _ ... ...� _..___ ..._ �� S cfly - i6 �.� ......_.... ! �_.._ .._ _. Final Inspection b .Date ...._ .. .' EH 13 24 1-68 itevil 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M