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. Y s �L x - l.4 7° •J - v 3 1.4f l '6 FOR OFFICE USE: i4 APi'LICATIOW'FOR SANITATION'. PERMIT ------------------------ ---- �� ,. - ^ '�� Permit No. -_-- �_ _ ---------.....-� -.�.�...--- .�.�.:-��.�:. �•-- -(Complete-in Triplicate] "'"" ---------- ---------------------------------------------- i Date Issued _40- �� This Permit Expires 1 Year From Date Issued made to the S n Joa his permit Local Health District for a permit to construct and intall the work herein Application is hereby a q described. This application is madeejji compliance with County Ordinance No. 5,499�and existing Rule's and Regulations: JOB ADDRESS/LOCATION -...... - --------� -------d__ti. r----- O C__CENSUS TRACT ---------------•---------- r�` Owner's Name _._ /!QY!p-----------�-------------Pf�_c_� ane _. ✓ �> r -------. Ci x Address -�-��!'F-- - -�------ ------- -� I --�-�-• --'---......-- Contra ctor's Name -._'��---/ _--.; �_�X �'__ 5--------------License # --- PhoneA :_10 ��_ Installation will serve.. Residence Apartment House❑ Commercial :❑Trailer Court i Motel ❑Other - ------ �j ------------- Number of living units:-_ _____ Number of bedrooms -4Garbaciee Grinder ------------ Lot Siie ------------------------•---- Water Supply: Public System and name __________ _--______ --- _______Privat _ {- - Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑` ,Clay Loam,E] Hardpan ❑ Adobe Fill Material ------------ If yes,typef.______ (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 SEPTIC TANK;'[ ] Size------------------------------------------------ Liquid depth -------------------------- I Capacity --- ---------------- Type --------------------- Material---------------------- No. Compartments ------ --------- Distance to nearest: Well ------------------------------------Foundation ----------- ------ Prop. Line ------.--------------- c LEACHING LINE ] No. of Lines ------------------------ Length of each line--,----------------- Total Length a----------."-.------------- ,, 4Y 'D' Box ------------ Type Filter Materia) --------------------Depth Filter Material --------- __-.._-------_------_.- _. � Distance to nearest: Well _________________ Four atian .__� _T____._ Property me= :___.__ -._-.--_= SEEPAGE PIT [ ] Depth ____ --------------- Diameter ---------------- Number ----------- ----------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------- ----- �`=�- : ------ � f . I Distance to nearest: Well ---------------------------------•----. Foundbfion;--------------- -- Prop. Line ---------------------- REPAIR/A DITION(Prev. Sanitation`Permit�# -------------------------------------------- Date _ .'--•-: -------- -------------) Septic Tank (Specify Requirement) -- ------------------------------ w------------------------------------- -------------- ----------•.< --------------------------- Disposal Field {Spci#y Requirements) N _ `` 3 ----------- _------ , ------ e�r �� ,fir:_1r . % �"�` ( ;--- -------------------------------- -------------- I------ I herebycertify that 1 have prepared this a li ation and that the work will be d e) (Draw existing and required addition on reverse side) {�, p p PP one in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin LocalrHealth District. Home owner or licen- sed agents signature certifies the following: S r "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 a ----- �. BY -- --------- -------------------------------'------------------- Title (If other than owner) !, I FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED B z, ¢-s-- --- -'-- -- DATE -€ --G`'--'�"3-7 7__1-------------- I BUILDING PERMIT ISSUED------.----.,.--------------- -- -•------------------- = DATE.... tADDITIONAL COMMENTS - ------------------------------- ----------------------------------------------------------- IF ,.. ' i ----------- ah-/ ----------------------- ----------------------- ------- ---------------------- - ---- --------------- --' -- /-Final Inspection b Date __-_�- - J---SAN JOAQUIN LOCAL HEALTH DISTRICT i 'E. H. 9' 1-'68 Rev. 5M