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FOR t ICF APPLICATION FOR SANITATION PERMIT ,r ------ -------• '0 ------ --------•------ (Complete to Triplicate) Permit Flo.'/___ ....." _ � . -------------------------------------- --•----- 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: Ag JOB ADDRESS/LOCATION1 .,1"-�~---- - `----..-'- --------------CENSt1S TRACT _.............. „_..... Owner's Name _ �tf--. .P �.e... !!0-- '-----•._ rAq �»�IY-- ---- -----= .. ..a tone .�_�� Address A 1 .- " ' City ------ b Contractor's Name --' -A AFI* 0,#-V Y-___"" -!y-_ -----------------License # Phone Installation will serve: Residence jo Apartment House f] Commercial oTrailer Court ,0 Motel C Other • •-•--- - Number of living units:....}_------ Number of bedrooms __.._.Garbage Grinder _- .r_. Lot Size Water Supply: Public System and name _-_ --- ------------------....___-_;_- ..... ........ .........---------------._.___:.Private Character of"soil to a depth of 3 feet: . Sand'C( Silt❑ Clay ❑ Peat CJ Sandy Loamo. Cloy Loam o Hardpan❑ Adobe je. Fill Material If yes,type..............._ __________ (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic,xcknk or. seepage pit permitted if public sewer is available within 20g feet,) PACKAGE TREATMENT ["] SEPTIC-TANK Size____ffiref ........... Liquid ....... Capacity ;'TYpe Material -•-- No, Compartments %,�,...... Distance to nearest: Well ------------2 d- ---_------------ --Foundation .... &- ........... Prop. Line _---• .......---- ` LEACHING LINE [ j No. of Lines .___ +_:.__----_-•_-- Length of each line:- --..rp........ Total Length ............... , Q' Box ----- ----- Type Filter Material # ___- -_..Depth Filter Material ---slz;_ _ Distance to nearest: Well --- ......... Foundation _ _ ______________ 'Property Line _ O SEEPAGE PIT [ J Depth --- -----._-_ Diameter 3Z.____--- Nurnber _--------- --------------- Rock Filled Yes No Ij Water Table Depth _.._. _____-__ _________ ______ __._..Rock Size ................................ __•______________Foundation.__ __ _ _._��C�_ - _.. __ Prop. Line _ Distance to nearest: Well '..______�_/�� ` . •? REPAIR/ADDITION(Prev. Sanitation P.e[mit# 7 � _-__ Date _± _'. .'+ ` __�__ -) -------- - --- - Septic Tank (Specify Requirements) -------------------------------------------------- Disposal Field (Specify,Requirements) ------•• -------- --.... --_----_------_---- ----------7---------- ------------------ - ---------------- - - ------------------------------------- .... ---------------------------------------------- ----------------- ----------------------------- (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�San Joaquin Local Health District. Homeowner or licen. sed agents signature certifies the followings "1 terrify that.in .peef' armonce,of tlfe work for which this permit Is Issued, I shall notemploy any-person. In such manner as to become subject j mi 's Compensation lavq of California." Signed Chvner ,� (I o r than'o OR :DEPARTMENT USE ON APPLICATION ACCEPTED BY -........... ---- ---• -- ---------- ......... DATE ...._7__/S'--7Q.............. BUILDING PERMIT ISS`UED,_ � AT, AD ONAL CO M NTS �a .rx-�• ce cP ------------------------- . - ............. - ---------------E ?a , Fina! Inspection by: -------- -------------------------------------------- -------- ----•- -- Date �__ ------ SAN' JOAWN''LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,