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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I- (Complel±e in Triplicate) Permit No. -~S7_---. ------------------------------------------------------------------- '�I' This Permit Expires 1 Year From Date Issued 3-73 ` Date Issued ,7 ______________ -------------------- ------------ ------- ---- .I! ,q �fJ '.. 2_(3-17 0-YS_ . Application is hereby mad 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: JOB ADDRESS/LOCATION _ -_..- i-----RAW-0- - ------- : __T_Q----- x- ---------------------CENSUS TRACT -----�Z------------- Owner's Name ----------------ItF ----&1-_L---------------------------------------------------------------- -------------------Phone ------------------------------------ ,F, Address -------------- 3.33117------- M t�'A_Aj�_=------------------------------- City ---`1_I21 t' --------- Contractor's Name ----------- I[--- CJC2 yvr_�� -----------------------------------------License # ------------------------ Phone ----------------------- Installation will serve: Residence [rpartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------------------- gGarbage - - er L---- Lot Size ----q.A--------------------------------- Number of livor units: _.__ ____ Number of bedrooms -_ _______Garbo_ a Grind _ _ :private 9 Water Supply: Public System and name ------------- --- ------------.--- - - - ----------------------- ----------------------- - Character of soil to a depthlof 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam 1:1 6, Hardpan ❑ Adobe [ ill Material ------------ If yes,type _-_--.__-__--_---___---- 7� v� (PI'ot 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 [ ];� SEPTIC TANK:"-- Size----------I_'o _ ____________________________ Liquid Depth _____________ Capacity ._*-�--- -- Type 16LTO 4------- Materia l_CJAW- --- No. Compartments --,a`°'L__................ Distance to nearest: Well ------�_ -----------------------Foundation ----/ ------------ Prop. Line .r3S______________ LEACHING LINE [ ] No.' of Lines ___---o[ --- Length of each line-------!P-------------- Total Length .119P___ " 'D'' Box .Tba----- Type Filter Material o -�ttC-_____Depth Filter Material ________19______________________________ Distance to nearest: Well ----ASO----------- Foundation ------------ Property Line --4.Q______________ I� SEEPAGE PIT [ ] Depth ------- ------------ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No .❑ Walter Table Depth -----------Rock Size ------------------------- 1M: Distance to nearest: Well ________________________________________Foundation ________.______ ---- Prop. Line ____________________-- !IM REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- 4 f SepticTank (Specify Requirements) ------------------------------------------------•--------------------------------- --------------------------------------------------------- Il` i Disposal Field (SpecifyRequirements) ---------- ------------------------------------------------------------ ------------- -------------------------------I-------------------------------------------------------------------------------------------------------------------------------------=------------------------ it (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 ri County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local health District. Horne owner or licen- sed agents signature certifiells the following: "1 certify that in the performance of the ork for which this permit is issued, I shall not employ any person in such manner as to bp o e ct Mork n' Co pensation laws of California." *. Signedr � --�'! II -- ------------------------ ------ ---------. Owner BY ---------------------------------------I ------------------------------------- Il--------------------------------------------------------------- - -------------------------------------- -- ------------- -Title --- -------------------------------------------- ------------------ (if other than Downer) FOR DEPARTMENT USE ON&Y APPLICATION ACCEPTED 8IY -------------------------------------------- = - DATE ---- L9 ------------------ BUILDING PERMIT ISSUED Ah._..._--.---_____________ DATE -------------------- ----- ---------------------- -- ------ - -------- ------ ADDITIONALCOMMENTS ll ------------------------ - - ------------------------------------------------------------------- --------------------------- -- ---------------------------- - ------------------------------------------- !------------------------------------------------------------------------------------------------------------------------------------------------------- t ------------------------------------------------ Il --- ---------------------------- -----------------------------------------------------------------------------------------DFTRICT ------ - ij: Final Inspection by -----------------------------------------------------------------•------------ -------.Date ----------------- __9 � --------------------- SAN JOAQUIN LOCAL HEALTH E. H. 9 1-'68 Rev. 5M