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FOIA OFFICE USE: APPLICATION FO.Rt SANITATION PERMIT ---------- ------ ---- ._ Permit No. 27�--- :----- I (Complete in Triplicate) ------ --=------------------------- -------------- - --------------------------------------I- -- _.____TTS: This Permit Expires 1 Year From Date Issued Date Issued .--1-��f -71-- 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION- _' �t7I= --------�____.FI_F� -F___--S' --------------------------CENSUS TRACT _;-=✓. ..._-- Owner's Name '----._.1__d C-!-5- '------- -L E`�5 - - --Phone _� ----------------------- _E ------------------- �_.. :_ Address . r'�- ------•F�- ` ' - city �_C _ Q rV Y - - == - Contractor's Name ----QW/ .F-R------------------- ---------------------------- ------License # --------- :"`Phone----- ----------------------- Installation will se�ve:�a=a�� Residence Apartment House,[:] Commercial ❑Trailer Court ;❑.'.� I Motel ❑Other ------------------------ ------------------ Number ----------- ---- / f ; Number of living units:___-_-.- Number of bedrooms -73------ Grinder -l-Y-6--- Lot Size- 4D4 a -�--_ - ----- ----- - -- Water Supply: Public System and name ---------------------------------•-----------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand ;"" Adobe S' Gay E] PeatTid__ Sandy Loam �(ay Loam D Hardpan [:] Fill Material r-If yes, type ___z ----------i.--- (Plot plan, showing size of lot, location of system in relation to w.e`fls,41a' ildings, .etc. must be placed ort reverse side.) NEW INSTALLATION: (No septic tank or seepage pi p�rmitted�if public sewer is availabl within 200 feet, PACKAGE TREATMENT [ ] -SEPTIC TANK'[ ] Size`I ------------------_-------_-•_--"___-- - Liquid Depth -{_----------.--_•- i ------`jf 11 ----------- -------- }mentsi [ Capacity --------------_____ Type 'I Material__ N Compart F ! } Distance to nearest: Well ers thyof'eachlineFoundation-_^•-'___- Total ' op. Line --------•---•:-•••.•-_ LEACHING LINE [ ] No. of Lines "y---------------- g r Length _--1._•----,---------------- __ ria1�___ _.---_----C-_-_-Depth Filter Mat rial ----------- Distance to nearest: Well ate YII l[ Property Line ------------------•-..-- YP _-- Foundati.on________------------- SEEPAGE PIT [ ] Depth _________ ______ _ Diamet r ____..__________ Number ..--._._.-_'_---.___ .__ ___ Rock;Filled Yes ❑ No '❑ t Water Table Depth Rock Sizei ;_Distance to nearest: Wel! _____ Foundation ___'_ - ----------- Prop. Line ______________________ ---------------------- I'"' t k t I REPAIR/ADDITION(Prev7zSanitation Permit# ________------- ---------------------`----- Date ----------------- ; .�� --------- ----------------------------- Septic _--__--_} q f Septic Tank (Specify Requirements[ ------ - .-_-- -=--- _ Q-Q=__4_._i--- .___r- OOM--_-___1-'_Cp1_TtOf- f � Disposal Field ]Specify�equirements) i------- --.-- p >l- ------------ ©/� -1- .c________ T(-L % a � ; _0_1 ST i 13 0 I { �� 4_ 41f X - ------- - --- ----------- --- C -- ^_~- [' 1 (Draw existing and required addition on reverse side]` r� { 1 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 Heci h District.'l ome owner or liven- sed agents signature c tifies the following: {{ C �-7 "I certify at in the a erformci c f t work For which this permit.is issued, 1 shall not employ ariy person in such matinee as to bec a sub' t toi War ' n's work laws of California." " r Signed - ---- --- ------------- --- -------------------------------------- Owner BY - -------- --- --------------- ------------------------------------------------`%� � Title --------- ------ F . (if other than owner) i FOR DEPARTMENT USE ONLYf APPLICATION ACCEPTED BYEI- `0t - ----------------------------------- ---- ------------- DATE �s - x � ------------ BUILDING PERMIT ISSUED ---;-------------------------------- DATE --___-- =-t. `--- ------------------- ADDi-TIONAL--COMMENTS :- '_'_= _= =--- -----------' _: __= ==-=_- ` "'_ _`'':__ = = I ______________________________ ______ - r - - ----_-_---_-__-_-__.____.___________________--------------------------- - - --- ------ ---•---- 1 Final Inspection by: -- _ -- Date ____-- __-- ` -------------------- ---- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M