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7�r FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT a�-o -........................................................ Permit (Complete in Triplicatd - Date Issued _...-. ........ ....... .....TIAD_..... ._.... ThhPermit ELcplres 1 Yea�rFrom Datelsswd 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 Regulationsr JOB ADDRESS/LOCATION ... C .� . _,..0. _....A.v:.t,n-- y,4-.._.....................__.,........-.CENSUS TRACT ..._.. ................... Owner's Name ...G--S,.1 S......... A n... ............................................:.:..Phone ...... Address ........---2.c?_`.1..--�_o........AGrin_A...........................................city .- P.n.. ..._.,....-----................................. Contractor's Name ...0.(,S_Q.-y-\....... -(9C K_l .C?_� ...............................License # t'577-V.94.___ Phone 8Zl_`7: 21cJ'.3_... installation will serve: Residence El Apartment House 0 Coommercial OTratler Court 0 Motel❑ Number of living units:_../-•___ Number of bedrooms�_.....Garbage GrinderN_Q__._ Lot Size -92.... ........... Water Supply: Public System and name .................................................................................................................Private in Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay ❑ Peat p Sandy Loam ❑ Clay Loam D Hardpan g] Adobe 0 Fill Material ............ if yes,type............... ............ 11�11�� {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 tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT j ] SEPTIC TANK{ j D Size......./ 4.4.__.f¢_!4 L,...__. Liquid Depth --B! �T.....,.... Capacity /___2._QQ____-. Typowas ... Materlal_GQ-.rM r_f4.?- No. Compartments -2. ............ Distance to nearest: Well ........� ....Foundation ,/P-PT------_ Prop. Line /QO:-P-r-0 LEACHING LINE [ ] No. of Lines _...`2_............ Length of each fine...... .Q........-...... Total Length th i..R._..t/6-(D ..6h-(.?.. ..........�.. DBox _-- -...... Type Filter Material lx. _eltK.Depth Filter Mpterial _____ ......... Distance to nearest: well ... 2- ... Foundation ..1..+L..6- ....... Property Line jQ�7PT...... 6EEPA ( 1 Depth .10: ..... Diameter-11X .C.. Number ..__._.�.............. Rock Filled Yes, No Water Table Depth ..............................r ....................Rock Size .....1.. _ rte. Distance to nearest: Well ...................Foundation 9P.:f'7_._. Prop. Line A......L..:! l REPAIR/ADDITION(Prev. Sanitation Permit# .......:.................................... Date :" . . { .......... Septic Tank (Specify Requirements) ........1_-Z-Q_Q...... . . ....................... .................... I.......... .... ...... isposal Fel (Specify Requirements) ........ ._.. ._ ................. .....:................ ----• ................... ------ fix. l. . ....•.... .... ._..----._._........._-_._. __.._.... -----------------------------------------•------------------.--.---- .......................................-............................................................................................ (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be den* in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Heeith District. Nom* owner or licew 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 Ql ..ca_h C� �� . _ ��itle ...... 4 (�.lj l� }.�--'---�_.-•---------__ (if other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --•- .- e' _,, __ DATE - _ ,/�: •- ........ BUILDING PERMIT ISSUED ...---_-- -- -,• -- --.._.._. -__-DATE --..................................... ADDITIONAL COMMENTS ./f'1�.�1 �._��;ik ..1e, 3...... ........ ._-----....._........................... . - 01 ------ - Final inspection by. .-:-- ._.Dated- EH 13 24 1-68 EV- 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M