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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT _ Permit No. ----- ----------------------------^ -- ------------- (Complete in Triplicate) -- ---------- ------------------------ -------------------- . Date Issued A4?1_(1--1?-- �"`This Permit Expires 1 Year From Date Issued` V 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 County Ordinance No. 549 and existing Rules and Regulations. L1�119✓'fxt S7r — Irl--- ar� �PY.JCENSUS-TRACT -------------------------- JOB ----------• JOB ADDRESS/LOCATIONPhone - - Owner's Name --------- Address ---------------------------------------- _ cityR .scam Contractor's Name __ ,_A_,- AQI I"s}�_ i---S�->�51-- -------------------License #2'6--'4' Phone . (c(c-"9407-----• Installation will serve: Residence ❑ Apartment House Commercial:❑Trailer Court Motel ❑Other -------------------------------------------- Number of living units:..-.--- Number of bedrooms ------------Garbage Grinder ------------ Lot Size ------------------------------------------ Water Supply: Public System and name __. �5 PP Yy .__------------------------------------------------------ ------------------------------------------------Private fi Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam ❑ V� Hardpan ❑ Adobe% Fill Material ------------ If yes,type_. -------._--------------- (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 [ ] SEPTIC TANK f ] Size._ . '_$---� P} ,A iPHCR.--. Liquid Depth -------------------------- Ca acit 9AL Type MIC PI Material C -_ No. Compartments �a.................. P Y^ YP 51 Distance to nearest: Well ------------- Foundation --�� -----____-- Prop. Line _Z ---=•------- LEACHING LINT= [ ] No. of Lines ------------------------ Length of each line--------------------------- Total Length ---------------------------- 'D' Box -- --------- Type Filter Material --------------------Depth Filter Material -------------------- ----------------------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line -------------------_.... SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Fil[ed Yes ❑ No 0 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- _ Distance to nearest: Well ----------------- -----------.Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------• ----------) Septic Tank (Specify Requirements) ------------- -------------------------------------------------------------------- ----------------------------<-------------------------- Disposal Field (Specify Requirements) IV -----Tt? € lsT7i2A113. ------- ----------------------- -------------------------------------------------------------- SY3FM (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 signature certifies the following: "I certify that in the performance of the or for which this permit is issued, I shall not employ any person in such manner as to become ect t sat ` Workma s Co p i.on sof California."-- - ------ - (-Signed �_ Cv -------------------- Owner A ��Rgl` 1. .Sc►►.fS ------------------------ -------- Title C21? R1'C BYE ' (If other than ow4r) FOR DEPARTMENT US O APPLICATION ACCEPTED BY -------------------- ------------------------- ---------- - ------------ �- ATE ...... - 9----------------- BUILDING PERMIT ISSUED ----------------------------- ---- - -------DATE ------- ----------------------------------- ADDITIONALCOMMENTS ----------------------------- ---------------------------- --------------------------------- I----- --- --------------------------- ------I------------------ ------------------------------------------------------------------------- -------------------- ------------------------------------------------------------------------------------------- ------------- _ - ------- --------------------------------- ---- ----------- - - - - - - -- - -- - - _ ----------------------------------------------------------------------------------------------------- - Final Inspection b ----------- ' --Date --- - c ------------- - ------------------- ,- SAN JOAQUI LOC HEALT IS, T '� E. H. 9 1-'68 Rev. 5M