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.� . FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT :- � �► --��--��-- ----------------------------------------------------------- (Complete in Triplicate) Permit No. This hermit Expires 1 Year From Date Issued Date Issued _ _ - ----------_--_-------------- Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is ompliance with County Ordinance-No 549 and existing Rules and Regulations: 6 JOB ADDRESS/LOCATIOP7' ~��"' '"`-- ------ _.CENSUS TRACT __ -----Y-7_..-____-- �_.. :- i-Y[____ Owner's Name -p---- ---._';��_�-_,_,;.�-.....�--=---�•----La-----------�_•---� 1-1 -�r.,��one---------=--- •- •--------•--------- OTT Address I-31.5 .. `�� ---4N..ti ff . City --± C Phone ----------------------------- fa ContrInstallation will serve: Residence partment House-[:] Commercial f # { actor's Name -------Q_ - ---_-;�--------- Li lciaf ❑Trailer'Cour-tj',❑ Motel 0 Other ---------------------------------------------- 1f!-- ; �j 9 ; Garba 1-- rti( At Size -gig-/ x �•`,�1-----•----- ----------------------------- -------------------- Number of.iivin units:_._ Number of bedrooms _ Garbage Grinder Water Supply. Paola deic sth of 3tem f ee#:meSand' • Si t, Cla Peat Sand ="1--------------------♦------------ ---_-_ ��'-Private ©� Character o so' p ❑ ❑ y .❑ ❑ y�Loam ❑ Clay Loam ;[ i €, - " — - - Hardp.6n Adobe ❑ Fill Materials- 0_- If yes, type.------- ------------------ t.i �i - (Plot plan, shovNng size of lot, location of system in relation to wells,�'kuildings, efc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seeps a pit permitted if public sVw9r is avil ble within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK [ Size____�_XX --_---- Liquid Depth ____ ________..___----- ' Capacity _� E?. ___-` Type � F -13- Materiali'- ----- _ No. Compartments ____ — t ' E - 11,/ istance to nearest: Well __ ._-. �___--- ---------r'Foundation 0_77v------- Prop. Line ___ __. ___.- ~ t--{t ----- Total Length ---- __--------- Type: _ ._ LEACHING LINE [ No. of Lines ______- ----------- `Length of each lin'eY_�'__.Z_��_____ i. • - --- "--' Q `D' Box��.S- Type; Filter Material �dG�n( Dep#h Filter�lNa#erial ___________ _______.____:__- .._____._.._._ Distance to nearest: WeII.F__ 00--------_.__ Foundation .--_- - ___.-____ Property Line- ____:________ J SEEPAGE Pit [� Depth --��--.------ - Diame�r .X_ _---- Number- ------ ----------- Rock Filled Yes No it t t-' ck Size -- Water Table Depth �b '= � o ` J -- J Distance to nearest: W&Il ------ __---- _`_------ iroundation ___-�------ ---- Prop. Line /-- 0_ ZJ_________________ REPAIR/ADDITION(Prev. Sanitation Permit# -;-�--------------- ------\--` ---- Ddte ----------------------------------} ----,-;--, Septic Tank {Specify Requirements}..�j=--" °=_=-----.----•--------- --- '------------=1-------- . -•------------------------ .,• F { k---•--------------- Disposal Field (Specify Requirements] i ---------------------------_- ----h--------- I _---------- --- C Jit =ill i 4' -------------------------------------------- ---------------------------------------------------- ------------- - Kiri �w J---- - ------------------------------------ - -=---- - - - 1. }��' u..; (Draw existing and_required-additionson-reverse side)' ,"=_1 'i r1 \ S �-; i 1 I hereby certify that;.)=have prepared--this-application-and_that of-the-work-will will_be done in accordance with San Joaquin County Ordinances, State Laws, and' Rules dnd Regulations of the San {Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: ' "I certify t a in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to bec m subject to Wat n Compensation laws of California." Signed ..._--- l_LAMA-------------- --------------------- Owner By ---------- -----=3=------------------ t� `-_`Title- - ---------- ------- -- (If other than owner) �,. FOR DEPARTMENT USE ONLY APPLICATION_ACCEPTED BY _. L_ = = .........n } r�..DA�i;! t _ =.t_„ ---- BUILDING PERMIT 115-Sag --------- � ------ �------- __._. ------- -----"-`- _. ._..`:_DATE ----- ---- -------- ----- ADDITIONAL--COMMENTS—_- ---- -- -- -- - - ----------------- - , - ------------------------------------------------------------------------ r ------- --- ------ '. t3 t i ti f - -- --------- ------------------- ----------------- ------- l ,------ ----- y -----} - - - -.-.-,-..--..-�----.--. - -.._-_--- w - . - - - --------= �----7 Final Inspects --- --- ° --�-_ _ ----- - `- �-�=- --- SAN JOAQUIN LOCAL HEALTH DISTRICT ! E. H. 9 1-'68 Rev. 5M