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FOR OFFICE USE: pppLl>CATION FOR SANITATION PERMIT / 3 3a Permit No: //'s� 31 �� _ --- lComplete in Triplicate) r z/ � -------- -�-'---- ---- I-- ---- Date Issued -------------------- j717 /� .�a �r This Permit Expires 1 Year From Date Issue - -- 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 i ompliance with County Ordinance No. 549 and existing. Rules and Regulations: { 4 JOB ADDRESS/LOCATION � CENSUS BRACT ------- f Phone ------ Owner's Name ------<2 -41 Imo/ %Z / Cifiy tf it� fL�J- -------------------------------------- ---- 1 Address ---------I ��---�'�---------a-f�_t_-----e+ llde�� ---------------- --------- Contractor's Name __'1417_0 = rte' ---------------------------- - License #f ` '2-r-- Phone�JA,�'f ��`�-- ❑ Commercial ❑Trailer Court ;❑ Installation will serve: Residence Apartment House Motel ❑Other _ - _ -------------------------------- --- - - - ___Garbo e Grinder C�-- Lot Size A/0/-A-4 of living units .... Number of bedrooms ________- ` g� .�-- - Water Supply: Public System and name141A1' �- �° Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt El Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 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,) ff ` j Size_ i = ----- Liquid Depth ! ------------.•---. J PACKAGE TREATMENT [ ] SEPTIC TANK'( - � i ' -----,T a ___ Material �e�11�-�---- No. Compartments Capacity�i4�Q Yp ��'�� ' Distance to nearest: Well _ ""r=r7' --"------------Foundation -_-12P------------ Prop. Linez_le---------- s ` LEACHING LINE A No. of Lines ------ _ Length of each line--- Total Length th �d� ---• e Filter Material �� yV epth Filter Material -`�--------------• ,�D' Box ' _ Typ f 0 _/_-Q------------- Proper Line " Distance to nearest: Well ____________________�J_ Foundation - -- Property _ __ Rock Filled Yes)K No ❑ ' SEEPAGE PIT Depth 4--- ------- Diameter ` --"---- Number ----,2---------- -f �- Water Table Depth --------- �--------------------------- Rack Size 1 _ r -------------Foundation cA�--------- Prop. Line : -- ----•----- Distance to nearest: Well -_______'------------------- -------------------- on ) I REPAIR/ADDITION(Prey. SanitafiiPermit# ------------------------ Date _:__:___ - . ----------------- „---------------------- Septic Tank (Specify Requirements - ---------- Disposal`Field (Specify Requirements) "------------------------------ - --------------------- ----------------------------------- ---------------- -----=-- - - --- - - -- - - - - - ------------- ---- ------- ---------------- ------------- - (Draw existing and required addifi;on on reverse s d e] 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 Health District. Home owner or licen- sed agents signature certifies the following: x arson in such manner "I certify that in the performance of the work for which this permit is issued, I shah not employ any p as to become.subject to Workman's Compensation laws of California." Signed ------- ------------ ---------------- Owner - -------------------- - ---------- --- ---- - Title ------ ---------------------------- --------- (If other tha wned PARTMENT USE ONLY - ------ ---------------------------------- ----- DATE _.__ 7`,�/-------------- •. APPLICATION ACCEPTED BY -__.______ F BUILDING'. PERMIT ISSUED ------ --- -- ----------------------------- DATE ---------------------�--------------------- ISSUED ------- ----------- - F BUILDI G'. P COM ' ----- f ------- - -- - ------ -------------------- -i 4 -- ---------------------------- ---- ------ - Date 7=/4 :!-7/------------------- I Final Inspection by: - ---- r "- SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. M '_