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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _:.7 .-.633 This Permit Expires ] Year From bate Issued Date Issued Application is hereby made!to the Son 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 '9.... ,. .. _ .. .--- O-. �pR o ...-........ ... ..............CENSUS TRACT .......... . Owner's Name .............J-�>-s-Cff.....Z..1?VgP ----•--..- _. . .... _ • -----,•--•....................:.................Phone Address .., ��.JQ-v►ti ...r "'w" . -- Y G�14 ti .. ................ Cit :tiC' 4� Contractor's Name bra _ ;i f � Ci nse #- ` - - ��5�-�-=,3.f�. Phone ................ � Installation will serve: Residence ❑ Apartment House[] Commercial ❑Trailer Court 0 Motel (`Other . ftRA.f6- fi{pxu.Q. 1 r �. e Water Supply. Public S stem' Number of,bedrooms __-, Garbage Grinder ._. ...__... Lot Size ....4•--•_•__ • __ Number of living units ..... h Character f sol! to a de fh o`and nam P _. Jr '�..,------;..._..........•--•----------�--"'�'-�-=.:~.....Private ❑ I r o w 'f 3 feet:.k Sand Silt Clay \ #'s' P$`",-3 �.� 4$1 ter ❑ ❑ Y ❑ 1 Peat❑ Sandy loam ❑ 2CIay Loam ❑ '-Cffdrdpon ❑ Adobe f116 Fill Material ...... If yes, type (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) PACKAGE INSTALLATION: (No I�eptic tank or see6age^pitAperm tted if public sewer is available within 200 feet,) ACKAGE TREATMENT [ I ..SEPTIC TANK + a �r I � ) `> 3 Size........ .....•.... .......------- Liquid Depth ......._......• � � t d � Capacity . � T p e • . ._..:...._ t li t e yR. �, Material:---•- . . ....---• No. Compartments ....-..............r Distance to nearest- Well t- � ) 0 -• - ----� Foundation -..._..-1 Prop. Line -.x LEACHING LINE �M � '�' �-- -.- . - -. 1 [ ] No. sof Lines Length of each) line ,........ .... "......__.-. Total length i D' Biox ..-.- . . . Type Filter Material ........... ........Depth Filter Material _ ... .._ i p Distance to nearest: Well ...... Fouindation ._.... Property Line SEEPAGE PIT C ] Destta� ` ....�_ � Diameter ----•----- _._.. Number, ''� Rock Filled Yes ❑ Nog Water Table Dept:-------._ '_ �.._i2•ock Size .... .......... . .. . i REPAIR/ADDITION(Prev. -- ce to nearest: Well -------------------- Foundation ... ........ . ..-.... Prop. line ..................--..Aw, SanitationI Permit# .------ * / ....... Date ------.'.......... .... Septic Tank (Specify Requirements) --.. • ------------------ ---------------•----a, .... --- : ._. .DisPosal Field (Specify Requirements) ........Jbp,°__- .................' rr P { .. . ............................................ (Draw existing nd required d I dition ev on rerse sidej. I hereby certify that I have plrepared this application and that tate work be dons 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 l I "I certify that in the performance of the work for which this pe ret is issued, I shall not employ any person in such manner as to become bject to W kri`tan's Compensation ILws of California. Signed .: (7 ........ .. . By .... ... .. r Title i. . :x. (If other than owner) ..... FOR iDEPARTMENT USE ONLY APPLICATION ACCEPTED BYA BUILDING PERMIT ISSUED ---- DATE :..�-... ADDITIONAL COMMENTS ......!1.---.... .. ._ '..;...DATE . .... ---.--- --------- Final Inspection by: ----- ......-•-- •-- ----- D --- ----- ..----------- ate � � � N JOAQUIN �LQCAL HEALTH a Dl$TRICT ctoE. H. 13 24 1-'68 Rev. 5M— ::� __ � � 1 7-1S .s I