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FOR OFrld USE: -- �' APPLICATION FOR SANITATION PERMIT Permit No: 7a _/bdz G = IC*mplete in Triplicate) Date Issued --- a__� - Y This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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 �------- --- ---- ...... CENSUS TRACT --------- � ---- Owner's Name -------- ----R)q-N-K-------------- 1"V1I.�. -----------------------------------+ ----=:Phone - --- 176 t1-� i lL -------f 1)-•-------. city -` I �-_Q --------------------" Address __._ --, � ------------- Contrdctor's Name ----- � /Il __: - -------------------------------------------License# Phone - "Installation will serve: Residence partment House❑ Commercial :❑TrailerNCourt ,[] r` Mot�i.❑Other ------ -------------------------- ' • Number of living units-_ Number Number of bedrooms ___ __.____Garba_ge Grind Lot Size _ _ <RF_AC_�---------- Water Supply: Public System and name ------------------ -------------•----------- ------------------------------------------------------ Private ®� Character of soil to a depth of 3 feet: Sand';'_�A��obe Clay ❑ Peat❑ andy Loam.❑Hardpan ❑ Fill Material A127______ If yes, type ----------------------- (Plot ________ ___________(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 seep pit permitted public sewer is available within 200 feet,) <t PACKAGE TREATMENT [ ] SEPTC TANK[_ �t SizeJ�_�\__r_�__ __. ______________ Liquid Depth ___-��-----•-.------ � Material-_[�JVCKTo. Compartments ----- ------ s _ Q - -- r P / stas'�ce'#o"'nearest: Well _ �_ " _.________.Foundation ____f,t ________ Prop. Line _ -__ ---- ` ---- __-- Length of each line-- fl �-P------- Total Length ------- LEACHING LINE [" No.`bf�Lines�-- =- . � 9'D' Box��- Type Filter Mate�a) RO-C�_bepth Filter rMaterial ------ --- ---------------•------f---------- �� / d 4- .Distance to nearest. Well ___ -.-t_ _.Founda�o [ -- Pro.perty—L _ --_ -----.•.----- / ( Diameter/ Number_�' _I /h ,�� ' llfSEEPAGE PIT [ Depth X Rock Filled Yes o .❑Water Table Depth ----- ------�----- ---•-------.Rock Sizj-Distance to nearest: Well ___-_ ------- _Founcic16 _____________ Prop. Line _....J__....._-___-- Septic Tank (Specify Requirements) __ ___._ _ --------; ) , ' REPAIR ADDITION(Prev. Sanitation Permit# _.____. ------------------------------------ Date _--____i j € —Z � - ------------ --------------------------------------------------- --•----------- 1 Disposal Field (Specify Requirements} __________�Q_.-______ \ f ' �7r- ��_r� Qr }�-- ---------------- --------------- -- --------------- - - - �. (Draw existing and required addition on reverse side) I hereliY'`certi that I have re4 are this application and that the work will be done in accordance with San� Joaquin County\Oedi�ii races, S aws;Pan Rules.-,and :Regulations of the San Joaquin Local Health District. Home owner licen- ,_sed a ts,isiatur r 'fies the f owing?.� c :a:•. ` `1 vert€ y i f-tka work for which this permit is issued; 1 shall not employ any person in such manner c. 3 !' .as to bec s ct to Workman' s Compensation laws of California."\'L �,, `�.y4. "V � _ ------------------------------------------ ------- wn e -Title F _ --- --------�-_---w-.--_- -------- Y ------------ ----- - (If othe'r than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ �r ------------------'---------------------------------------------------- DATE -------f `"f "_7�z, BUILDING.mP.E.RMIT ISSUED ------------------ __.....___.---------=- __---_r_1____---,,,, _ :.___DATE ---------------------- ------ ------- ADDITIONALCOMMENTS ------- --- ---- ------ ---- - - --- _ --- -------- ---------- --------------- --------..-------------=--------------------------- `� 1 _ �'- -'' ---------- -- ------------------ _ -- -- --- --- --------- 1 - --- ---- D Final Inspectio : _ ate ------ ----- N0 SAN JOAQUIN LOCAL HEALTH DISTRICT H. 9 1-'68 Rev. 5M