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FOR OFFICE USE, * APPLICATION FOR SANITATION PERMIT ` Permit No. {Complete in Triplicate} -------------------------------------------- ------------ This Permit Expires 1 Year From Date Issued Date Issued :A _4� 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. 549 and existing Rules and Regulations: 4v _ JOB ADDRESS/LOCATION ------ ......... bnj_�.-------M>,----------------------CENSUS TRACT ----�'- �------ , Owner's Name -------- ----4-n-1---------IM-D,'4J, --------------------------------------------------------------------Phone ------------------------------------ Address ------ -------�------✓POV --.__---------R t�------------- City SC -Lf --------------------------------------------- Contractor's Name -----l-.l�t6t_----0�_W+Lr-------------------------------------License # --------- ------ Phone P_3-_�__----------------- Installation will serve: Residence Ef Apartment House[] Commercial :❑Trailer Court ,❑ Motel ❑ Other ------------------ -------------------- ---- AA � n Number of living units:____------ Number of bedrooms 3-._...Garbage Grinder /v-a_.__ Lot Size ---t4GRE/ & — Water Supply: Public System and name -------------- ------------------•-----------------------------------------•----------------------------------Private ®� Character of.soil to a_depth_of-3 feet:-_,__ Sand❑ Silt❑ ❑ - .Gay., ,, Peat❑_ _Sandy Loam -El., Clay Loam _ Hardpan dobe E] Fill Material _-_LU_a If yes, type --------------------------- (Plot _____ __________(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: kY(No septic-tank or seepage pit permitted if public sewer is available within 200 feet,) 01 PACKAGE TREATMENT [�] 'k-SEP_TIrCJTANK.( ] - . Sze------- ----- --- ----------------•------ ----- Liquid Depth -------------- - _ - N CapacitY -------=-------- -- Type ----- -------------- Material--- ------------- a. Com artments ----------- ----------- Distancelto -nearest.-Well --,-_:_ __:__, Foundation Prop. Line ______________________ „�. LEACHING LINE [ ] No. of Lines Notal LengthL _ ----------- 'D' Box ------------- Type Filter Ma erial _____________-_____Depth Filter M terial ---------------------------------------------- Distance :__-_______ _Distance to nearest: Wel' I "'-- "—`�"`u—n `�-- "` •`""""" -•-"- ^ - { - ------ Foundation -------=------ -- - Property Line, ------------------------ SEEPAGE PIT [ ] Depth''°- _____ Diameter ________________ Number'-_`):: _ __'_�_. ----- Rock Filled Yes ❑ No i❑ Water Table Depth ------------- �Rock'Sizea "-- 1------------------t- S � s Distance to nearest: Well --------- ------------------------------Foundation ----- -------------- Prop. Line ---------------------- . 1 REPAIR/ADDITION{Prev. Sanitation Permit# ______________ __________________________ Date ______________... _ • SepticTank (Specify Requirements) -------- -------------------------------------------------------------------------- --------------------------- --------------------------- Disposal Field (Specify Requirements) ------ r_5T_-__ ---- ____` '` - 11i'N. C7 �-----rt`o-----l-CL_ ----14FncH:-----�4Al - - &��P&_6J � x � ` X ��J`- �-�= ��' � ` of ,s �` =- -------------- = _ ,-------------- -------- -------------------------- - ------------------- .� i (Draw existing and required addition on'reverse side) I 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 Health District. Home owner or licen- sed agents si ature certifies the following: "I certify th in the-perfor ace of the ork for which this permit is issued, I shall not employ any person in such manner as to beco a subject to W k an' om sation laws of California." Signed�.� ________ Owner ------ -- -------------------------- I BY ----------- -------------------------------- -- Title ---=------- ------ (If other than owner) FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY _._._ �___________________ -------------- ------------------------------------ DATE -----5.7_`5--7�-------- BUILDING PERMIT SSUED - _ -• ----- ------------ ------- ---- -—DAT E ADDITIONAL COMMENTS f�L7='__ L i- ,.J{ a --- -. T T „— ___ --------------------------- 75 _____________________ _- _________________-_--- _ _____ __. _ __-- __ ___ __._________-_____________________-__ - _____ _____._________.___.________-_ Final Ins ection Date ___________ ___ P _ -- ----------------------------- --- `�� -- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M f