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IRR OFFICE USE: .d . :._ .. _.,_b........... _..._. aa...s.cod Oy APPLICATION FOR SANITATION PERMIT •�G (/' Permit No:�%a„`.�f ...................................................... (Cotnplete M Triplicate) ....... ......... This Permit Expires 1 Year From Date Issued Date lssuedc�.:�7:.� k 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, JOB ADDRESSAOCATION ..... �'. ' ---......... ....-CENSUS TRACT Owner's Name .... �i.tid _ F` Address Phone ..................... --.. ..........:::.... Contractor's Name eLr / -- /f_ ani w........license#�7f .7.7 a .1...- Phone - � Installation will serve: ResidenceV Apartment House❑ Commercial:]Trailer Court �! ` '-Motel ❑-Other Number of living ' Number of bedrooms ; units:..-,/---- rba a Grinder �(LQ..-•:, Lot Sino .l Water Supply: Pubic System and name -•••••-•..................... x ' ' � °...............................................Private❑ Character of soil too depth of 3 feet: Sand r] Silt❑ Ga _ - y p_Peat Q.Y-.Sandy Loam❑ Cta loam Hardpan❑ Adobe�( Fill Materia€ .......:.... If yes,type (Plot plan, showing size of lot, location of system in reldt€on to wells, buildings, etc. must be plaited on reverse sides NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT .F } SEPTIC TAMC } Size._.- � . o�1J..�._ _!��--------•-••-- -•-• Liquid Depth _ Capacity , .-/-Type alC7�"Material aV- No. Com artments Distance. ------- ------Foundation -_/b..to nearest: Well � •�•---••-----�-- - - LEACHING LINE r . . ....---,.�. Prop. Line _ No. of lines _... „............. Len th of each line--.----� ----.-.-...... Tota! Length ./�0�.. 'D' Boz _/....... Type Filter Material - /A/WiDepth Filter Material .4 `. . ............................ Distance to nearest: Well ....^10AAC..... Foundation-=.� � � - ................ Properly SEEPAGE PIT - Line ....................... I C ) Depth E Diameter �` I ---- ........ Number --- .......... ...... Rock Filled Yes No (] 1 'Water Table Depth ....................................... cV yy• !/ - Rock Size ,1.,�.•,�r�..�...-----. s`. v _ , Distance to nearest: Well,_....1 � atioin .�� ... ..... ......... ................. PAIR ADDITION(Prev. Sanitation Permit I ----- Date z:..... . Septic Tank (Specify Re uirementsl f{` 1 P q .r ---------------- Disposal Field (Specify Requirements) ............................ i .. i •-----•---- _ -_ -----------------I........................................I........................ 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 Son'Joaquin local Health;District. Home owner or licen- sed agents signature certifies the following: a fir' l "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 e Own r By ............. V4 .. ...__.._. Title ----- - t other than owner • . ....... ....... - - -.----••---.....-- -• FOR DEP RTMENT USE ONLY ' APPLICATION ACCEPTED BY ___-- BUILDING -PERMIT ISSUED _.. - ._ :_•--- •-- ---- -_<_.: DATE -v;--.�.�?'.-"7.�...---.._.:_... � ADDITIONAL COMMENTS -----. � .w-- --.------ - 61��-�='""" ..::..3.ct1...: y, / '..--•-- - ,-.., _ . -- -._.. _ ...-----------------•----•---------•----•..................................... ----' -- - - _. X .. -----------_ L.. .. ..................................... - Final Inspection by: _.__-_- ..._Date .... .. s 7. EH 13 24 1-68 Rev. 5�i ` SAN JOAQUIN LOCAL H1:ALTH DISTRICT 8/7h 3M