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FOR OFFICE USE: �1 i ' APPLICATION FOR SANITATION PERMIT _._... ......................... Permit No. .. ....._.••---.. ... {Complete in Triplicate! - - ............4:�J This Permit Expires 1 Year from Oat*Issued Date Issued ll. _ Application is hereby made to the San Joaquin Local Health District'for a' permit to construct and Install the work herein ' described. This a_ppli ion is made in compliance with County Ordinanrs No. 349 and existing Rules and Re$ulcitlons: JOB ADIFRESS LO T1FFi�I : `�w:_ ,,/ / D O ..._...._._ �3...NlR1/.... iP. -•......................CENSUS TRACT ......_..................., . Owner's Name .....I-H".I4F7.--- ./. .1f.Q1r�._.-_5 .... „�17 ..:..... • ..Phone _..-- i .... ....... 4Address ....... �..... R ..................I.._...._ - City ---...--•--•• . .......... .......... i n Contractor's Name --------0W_?4F_ ....... ......... .................... ----..License # ......................... Phone .----•-•-•----: ........... l Installation will serve: Residence partment House{] Commercial oTraller Court [] � Motel ❑Other....................•-----.................. Number of living units:------------ Number of bedrooms ------------Garbage Grinder ----- Lot Size / C->3��............. i Water Supply: Public System and name ................................... '' Private- --......._...........................L............... Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ PeatSandy Loam 0 '1 Clay Loam ❑ Hardpan Q Adobe p Fill Material . . .f.7.. If yes,typeµ.:._ ' (Plot plan, showing size of lot, location of system in relation to wells, �uildings, etc, must be p . �3 NEW INSTALLATION: -`<�4� '`` - � ' w,laced on reverse side (No septic tank or seepage pit .permitted #f public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] S€ze. � Liquid Depth�. ... ........... .:.......... Capacity ty ---- --------_-_ Type � � Material.. G = .. No. Coi;partments.,�... �. f4 r g Distance.to nearest: Well -------�.,�...............•---Foundationr.� _.lf.7i`..._ Prop. t#ne,.__;�.:.:f.__--_-•-• LEACHING LINE [ ] No. of Lines ----- ----- Length of each line__......701"�._.: Total ,L ngth_... .�0.......__.. ILA ', Q D' BoxTypef /! .....D �Fiiter Materia! .... �3. .�1... ................... - i Filter Material c'� � .� Distance to nearest. Well _._ 7_Q_ ......... Foundatlon l!/.__..-..... Property 1Une .. 6 � ..._ ......... olt 1-3 .................... DI ....... Nt�lmtber---ter I 17 Distance-to nwnrAef. Wpil f - ! "�fi � .. :-�Pr6 a-�.... 1 - - - - - _= REPAIR/ADDITION(Prev. Sanitation Permit ------ ---------- •----------------------- _ Date . r . :.._.._.. n Septic Tante (Speedy Requirements. . ; c l x Disposal Field (Specify Requirements) -------.........:..� lt -----�,1 ._' N... .._.7 -, ?.c- c gx l ST/n/C .. }5�Y 7C/_------•-`7��?.---�P-5_. > LL ............ --•-.----- --------------------------------------------: - � ..................... (Draw existing and required addition'on reverse side) � P I hereby certify that I have ,prepared this applicationZd.that the work.will be done In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulatioies of the San-loaquin Local Health:District. Hoene owner or licen- sed agents signature certifies the following: _ E I certify that in the performance of the work for which this .permit is issued, I shall not employ any parson in such manner as to become subject to Workman's Compensation laws of California." Signed ------ -------- 1..... ....- Owner BY /Ki•.Grll� -....__... Title �._...--- .---- (If other th�onow�ned FO DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY QT� DATE BUILDING PERMIT ISSUE=D ........................ - -------.-..DATE= .............................. ADDITIONAL COMMENTS .____ 1+'Ir __ di6..._:h�pVt;FTo:-- ----G ` :::---: 'TiS :F- --- -- :::-- •---•-----•---- ------- --••----------------- •--------------- ---------- ----- -----• ---- - ---- • Final inspection by- --- --- • Date ..... ... .. � 13 21t 1-68 1 v. m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M i