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FOR OFFICE USE: APPLICATION`FORESANITATION PERMIT _ --------------------------------------- 3(Complete in Triplicate) Permit No. �!______ This Permit Expires 1 Year From Date Issued Date Issued _(0_77,1 f-zy i Application is hereby ma a 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/LOCATIO -------- '_V " ------ -----; --------t ---------:CENSUS TRACT ------ --------- Owner's Name --- 6L67401/1'/ - 40s1*_ -_- -------- Address Address - , --_ - P-hon e -- -------------------•-•-- ------- ------ ----------- city ---------------------------------------- ------ Contractor's Name _)l.4._ k= License# Phonetp ' f .. Installation will serve: Residence VgApartment House'❑ Commercial ❑Trailer Court C] y Motel ❑` Other Number of living units:------------- Number of IJedrooms--,_/ t..Garbage Grinder . ------- Lot Size __F -------- ,r`--c,__rv__:_______- Water Supply: Public System and name , -------)-- 4 -- - -- vat-------------------- ------------------ •- -----------Pri ei Character of soil-to a dept of 3 feet: , Sand 0 Silt❑ Clay-�iQ Peat❑ Sandy Loam '❑ Clay Ldam [] r ------------------- -------- Hard 'an Adobe : Fill Material ____..____ _ If yes,type F (Plot plan, showing size f lot; location of `system in relatio to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage`iit.._permitted if 0ublic sewer is,,bvailable within 200 feet,) _ _..___. PACKAGE TREATMENT [ SEPTIC TANK [ Size____ __: Liquid Depth __________________________ Capacity , Type Material-- - --- --- No..;Compartments ------•-------....... Distance to nearest:fWelE ____________________________________Foundation ---------------------- Prop. Line ---------- LEACHING LINE [ ] No. of dines, ------------------------ Length of each line---------------- Total Length ,_________ -----_---.. 'Dl Box ____.___.__ Type Filter Material,-,-------- ________Depth Filter Material ______________ -_ _ _.._.-__ 1�! it .. ^� SEEPAGE PIT [ ] D$th ----------------------- Diameter Number c e ❑ ❑ ---------------- -------------- . _ _ _ __ - - kF d S Water. Table Depth oc ae ...Dis'ance to nearest:i� ---------------------I Foundation ------- ------- Pr p. Line ------ REPAIR/ADDITION{Prov. Sanitation Pe mit#Wel---------------------------- --------- - --------- ------ -- Date-:.--_------.-----; _, 5eptic Tank.[Specify Req�i�irements) ------ --IF-- ---------- -------- i v it ^ ' r Dis osal`°Field (Specify �1Requirements) j X. �'` ` '" r: � r� t------ >------ T .- = [ II�'_ {Draw existin and re wired add on on r --- f . -------- - 1= E- - _ N g q e rse side) t G I hereby certify that I ha'v!e prepared this application and that the` ' y be done in accordan 1llirltfi San Joaquin County Ordinances, State 'Daws, and Rules and-Regulations of. the Say Joaquin Local Health Distrlct. I'M owner or licen- sed agents signature certifie,�s the following: "I certify that in the-perforinake of the work for wt h this permit is ssud;Ashall not employ any p rson in such manner i as to become subject.to Workmcrr�'s Coi; jOensaet&i I s of California." Signed ---- __ I -- Owner ----- ._ 1 Title By ` lu Cher t i6n'ow�j r]`"y , FOR DEPARTMENT USE ONLY �+ = APPLICATION ACCEPTED: B. /r - - DATE BUILDING PERMIT ISSUED I -- --- -- ---_- ADDITIONAL COMMENTS - J - - fir- ..__ __-_-._ -- ----- .r ;l ---- - •- _ . JIB - } _ -- - - -- :- ------- --•-- - ----------- Final Inspection by: v '" -'+ - `,- ----- -- ---- Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H, 9 1-'68 Rev. 5M. z �