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FOR OFFICE USE: d,� o APPLICATIDN MR SANITATION PERMIT ------------------------------------ �----------------- �.- Permit No. -?3�--`��3__ (Complete in Triplicate) �� ------------------ ------ ______________ __ ______ ___-------_--------------- This Permit Expires i Year From Date Issued 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 ..- -----,_ '/� _ -�,/ -- -= �-�-----' �-4��---------CENSUS TRACT -------------- ----------- Owner's Name -----rr4 • - )--------VIVA6- -27_V_�------ ------ -----Phone --- Address --- �' �. i/ ---------------------------------------- City // C G-- .1� :-------------- Contractor's Name - :ter _ rr� '. ----------License # S."e/,;_'73 Phone . z:5Q Installation will serve: Residence XApartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑Other -------------------------------------------- Number of living units----I-------- Number of bedrooms ______Garbage Grinder -.---------- Lot Size ------- � 0_____________ Water Supply: Public System and name -----------J_ WQ�iiI - -----------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loamf:) Hardpan ❑ AdobeX Fill Material If yes,type ________________________ N . (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) b NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth ____________-_________-___ jtlS ,tfCy Capacity --------- Type ------------=----- - Material-------------- ------ No. Compartments ------------- ----- Distance to nearest. Well ------------------------------------Foundation -- '---.------- ---- Prop. Line ._....._..---:-------- LEACHING LINE , [ ] No. of Lines ______/_____________ Length of each line_' '_� Q_ .._�_ _ Total Length ,-m-0111 ----------------- D' ---_______---_ . /� � it oocrSTAAD' BoxG -� Type Filter Material _�_ _ _Jlq____De.pthjilter Material -___�cF_ ______________________ Distance to nearest: Well ---1l--- Foundation ___ #_^-__-- Property Line _---_--__ •.��,,rrte� ` - , SEEPAGE PIT [ ] Depth off__---_-- Diameter _�•---�--- Number ---------/__________r._______ Rock Filled YesNo i❑ '-r l� ogrsTiAl� Water Table Depth --------— -----------------------------Rock Size _.. __�__/ Distance to nearest: Well _____________________________Foundation -------------------- Prop. Line ___-___-_---____-_____ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _____________________________-_.-_} r Septic Tank (Specify Requirements) ------------------------------------------------------------ - --------------------•--- ... Disposal Field (Specify Requirements) __ -- r -_ -- - -- -------------------•----------- d _. �: �V/jJ�/RQ�/]/¢� F ----------•------------------------ --ti V ... -------AX_4.S-rrc - - - - - - - - --------------------- (Draw existing anb 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. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become s t to W rkm n's Co pensa ion laws of California." Signed ---------- -- --- -- ------ � i-- -- Owner BY ----------- ----- ------------------------------- ------ --- - -- ------- Title -----�-•, c r (If other than owner R R ENT USE ONLY APPLICATION ACCEPTED BY ------ --------- -- - - --- --- ------------ ----------------------------------------------- DATE ---6- � -� '75------------------ BUILDING PERMIT ISSUED ------- ------- ---- - ---- -- - -------------------------------- - -- ----------DATE -------------------- ---- ------------ ' - ADDITIONAL COMMENTS ----- -- --- --- -- -- --------- -- _ --_-- - --------------------------------------------- -- ---- -- ---- -------- -- -- --------- or -- c - -------------------------------------------- - --- --- ------- ---------- -41�=----------- -------------------------------------- -- - ---- -- --- - ---------------------------------------------------------- ---------------------------- -- Final Inspection by: ----- - ------------- --------------------------- Date --- 6------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M. t _ Y