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FOR OFFICE USE::, APPLICATION FOR SANITATION PERMIT 1" - (Complete in Triplicate) Permit No. �/-�Us.. Date Issued _4q" �_(d.J IA----------- his Permit Expires IYear From Date Issued Application is hereby,m ade to the San Joaquin Local Health District for a permit to construct and install the work herein A ; described. This apt i 6tion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1 JOB ADDRESS/LOCA ION . IS3 z 2, W ' 1Z7_ . - CENSUS TRACT ll Owner's-Name 1 �- 1C ---- --- fl- _ Y11�-------------------------------- -------- -------Phone " ' Address ----/5-3-72 i, F"' g- � ------------ City _ Contractor's Name -- -------------------------- C-1--- -----I- --------------------=--------License # ------------ :52 ------------ Phone :523--------------- q Installation will serve: Reside 1 Apartment House f❑ Commercial ❑Trailer Court ;❑ �1l11 j otel❑ Other Number of living units:--J,--v-Number of !bedro&rsGrinderyrF75__._ Lot Size - � C` •, :__"___ } i ----3- L' i ❑ S s#em�and name:-- ---- - - ----------------• --------------Private 1 Water Supply. Public Character of soil to;a depth of 3 feet: Sind' Slit j Clay t ❑ y ❑ Peat❑ Sandy Loam �❑ Clay-Loam'❑ i{ �. ^^^- Hardpan ❑ ' adobe- Fill Material =:-=__- If es, -- - �. (plot plan, showing size of lot, locatioa o system in relation to wells, buildings, etc. must be placed on reverse side.} NEW INSTALLATION: (No septic tankI or ieepI spit permitted if public sewer is available within 200 feet,) \ PACKAGE TREATMENT [ ] SEPTIC TANK [ ]� Size __ _____ ___ _ _ ___-________ Liquid Depth ----------------.___,_____ - - - ------ - - Ca acit P Y �'-�- --}------- Type ----------------- - Material----------- -- ---- No. Compartments Barest: Wellies #fa�o -each iineFoundation ________________ __ Pr p. Line ---------------------- LEACHING --------- ------ �w Dis ance t LEACHING LINE L j Not of Lines n --------=---- - --------------.Total Len th ---------------------------- j a 'D' Box ___- -- Type Filter Material __ __ ___ ______Depth ilter Material ___ _____ ----------------- �1 ---------- Distance to ne-rest: Well _ lt Foundation ----s___________-- Prope Line _________________-____. SEEPAGE PIT [ ] Depth __-__ _t____i______ Diameter _ _________ ___ Number _ - --- -------- __________- Rock Filled Yes ❑ No t - Water Table pth ------------------------ - -4 Water De ------Rock Size -------------------------------- Distance to nearest: Well ------------------ --- --- --_-Foundation -------------------- Prop. Line ---------------------- < REPAIR/ADDITION(Prev. Sanitation Permit# --- ---- --------------- -__________ Date __________________________________} � I Septic Tank {specify Requirements} _ _p-----hf�P1[L/QQb----- A-K ------- -------- Disposal Field {Specify Requirements) 64LiT-----PR -Ff} ------------ ---_ -} ----- - ----------V?6RA_9r------Lx_(_S�r Sr ' ---- -�--- ---- --- -------------- 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, I shall not employ any person in such manner as to becom blect Workm the laws of California." Signed -- --- ----- ------ Owner BY ------- ----he ".. Title ---- ------------------ ( ------------------- ---------- ---------- (If other an ownerM FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ------------------------------------------------------------------------ DATEL Z BUILDING PERMIT ISSUED ------------------------------- _. ..�,_-.------------:-.- -. -------DATE ---- ------- -- -ADDIxIONAL_COMMENTS------ � — - --- 7-- - ------------------------------------ - --- ------------- Z. �;-' - -, - -- - ----------- - ---------- _---------- -------7--- ----- - _ �—= = n - - 1---- -------- ----------------------------------------- ---De --------- -Finai ISAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'6$ Rev. 5M .. 1