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FOR OFFICE USE: APPLICATIO�FOR SANITATION PERMIT -----------•-•------------=------------- • • ----------- _ P Permit No. .-,'/ _ . (Complete in Triplicate) Nt --------- - �'y Date Issued .. ........ ....... __.._._.._.. -- __ -- --0__________________________ This Permit Expires ] Year From Date Issued its- Application ts_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 ma j e in co Alia with gounty Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO TION _ .. .. ..../V------ 4 k- Owner's rjVTe .----------------------------------------------- ----------- ------=----------------------------------- sq Address ' ,- ........... rAkeuA_ 4ity _- - ---- ----------------------------- Contractor's Name /lA. ------------- -----------------License #1U,rA21'5Q_ Phone _ -1- ... n.55 Installation wilt serve. Residence)dApartment House❑ Commercial []Trailer Court ❑ - Motel ❑-Other ----- Number of living units!--- Number of bedrooms Garbage Grinder .__ .____ Lot Size -1 -- .................... Water Supply: Public System and name -_ ---.------.---------------------------------------- - - - - ---------------------Private ❑ Character of soil to a depth of 3 feet: San Clay Peat Sand Loam Clay,Loam p ❑ ❑ Y ❑ ❑ Y ❑ Y .❑ ) Hardpan% ] Adobe 5r, Fill Material ------------ If yes, type ____________________________ (PI'ot 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-seepagespit permitted,ifpublic sewer i�"" s a l3gle within 200 feet,) ' PACKAGE TREATMENT { ] SEPTIC TANK ] Size------------------------------------------- Liquid Depth --------------------------- Cap city -----------------•-- Type ------------- Material-----�-��--�-�------------- No. Compartments .......... D OA K&to nearest: Well ------------- _ � Fou' otion _...... --- Prop. Line ---------------------- i " LEACHING LINE [ I No of Lines ------------------------ Length of each line-.-------------------------- Total Length ._..__..._......___-......__ t 'D' ox ------------ Type Filter Material --------------------Depth Filter Material -----------------_.....__..._.._.t........ Dista"ce to. nearist: Well. -------•.-------•---• Property Line --------------- -------- rFaun at { l p l Diameter Numb Rock Fitted Yes ❑ fo SEEPAGE PIT De th' Water.: Table Depth ----------------- - --- ocic,Size__...._ ............. Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. :Line ............... ...... 7 rREP�IRcA pDklON PeaPe _ . Date �fix :- P }. (Specify Requirements t -- N t ........... Disposal Field (Specify Reiviremen - s) 1 1�- ------------------------------------------------------=- --- -'�-----� _.. _.... ..- ------ (Dr w exitinct and regvired addition on`reverse side)--.j i r A I hereby certify that I have pl,eparW tlies is application and that the work will be done in accoreldnce with Sae Joaquin County Ordinances, State Lawta, ail. and litegulahons of the San Joaquin Wcal Health District—Home, owner or Ilcen- sed agents signature certifies the followingJs "I certify that in the performance of-the:work for which*is permit is issued, I shall 4ni employ any pperson.in such manner as to beco To subj Work n C pensation laws of California." } „_ ; Signed - ---------------- --�Owner �r,.- -�-- B - T' ,le ---- -------------------------------- Y -- ------- --- - ----- (If other than owner) - I a OR WAi RTMENT USE ONLY APPLICATION ACCEPTED i3Y . ----------------------------------- DATE 11Z. h--•----------•--------- ---- BUILDINGPERMIT ISSUED ------------------ ----------------------------------------------.---------------------------------------DATE ........................................... ADDITIONAL COMMENTS ------------------------------------------------------ ------------ ---------------------------------------- --------------------------------------------------------------------------------------------------- •_._._.._..--•------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- -- Final Inspection by,: b ..-_-Date IV------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'48 Rev. 5M,