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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No �� 7 (Complete in Triplicate) . . ................... i Date Issued ............... 76 ..........- 1.. _...... This Permit Expires 1 Year From Date Issued 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 ADDRESS/LOCATION ,...�...lj +tom--+ .._.....W.k.F.,/V...r.'.4.....-...................................CENSUS TRACT .......................... Owner's Name , �,de.5.�... �!/ * (,t.� .�',�hr...............................................Phone�J_3b''�- �e 6,�...... Address .----------a_a.$a---- -A-P_-.Ar7-,LV"., . ................................. .... City ',/1. .................................................... Contractor's Name ... .,:.. ,#. -�.r a•%�! License # .�.Y.�.$.. Phone Cl.Y.7!.1113 Installation will serve: Residence§Z Apartment House❑ Commercial ❑Trallor Court 0 Motel ❑Other.......... ............................. Number of living units:...-l....... Number of bedrooms ...I......Garbage Grinder d/..40._.. Lot Size ...13.....tF-MWU............... Water Supply: Public System and name ......................................._..--------- ..........................................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam K Hardpan Adobe Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location of system Igtion to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepap't�p rmitted if public sewer is avail ble within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK f ) Size...,144 117 ... 4—Ar ... Liquid Depth .......................... Capacity/.2dtQ:..._.... Type 61� .......... Material...'................. No. Compartments ........ Distance to nearest: Well ./,�r� t r .�i'. . l/r ......................Foundation .Lo......._..._.. Prop. Line . _ �'............� LEACHING LINE [ ] No. of Lines .... ................ Length of each line...... ..... Total Length ....I ... 'D' Box .1........ Type Filter Material ....................Depth Filter Material .................................*....._... s r r r 8 VX px/0 Distance to nearest: Well ........ Foundation ..../0.;�......... Property Line ....,�.�..f'_..........� r � ■ T [ ) Depth .Ap........... i)iswas r . .. Number ...... ................ Rock Filled Yes, No (30 p ....Rock Size ./AA •`.-_.1fr.��.._... Water Table Depth f Distance to nearest: Well .-APA.t......................Foundation .,�®./�'-...... Prop. Line ....,S..I.......... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I Septic Tank (Specify Requirements) .......�..a„�d----px..ZZ 4 Disposal Field (Specify Requirements) .... ... j .... C&-----------------------_--- .................................... ,s� ✓ -- ------ --------------- ....................................................._............................................................................................ (Draw existing and required addition on reverse side) 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: "1 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 ... ........-------------------------•-••----•- -............._............._. Owner By ._. .�C,d- +A-..... ........................... Title ......40," . (I other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ...........................................................•-- •--.•......_._....................... DATE .......................................... BUILDING PERMIT ISSUED _....._ .. .., � . . � � .., . AD..AT AD . .. . G .,t,RITt ._....... r.......... ......... ....... . . ................---.....................................-----..............---............................------. .. ............ . .......... ........................................------•..................•--.............---............................... .........................•• .. ........ .... ...... Final Inspection by: . ... ... .f... ....... Date ............ SAN JOAQLAA LOCAL HEALTH DISTRICT E. H.13 241.'68 Rev. 5M 7/723 M