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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT � t L Pe Fmit No. ---------r76----5-- ----- � --------------------f-------------------------------- (Complete in Triplicate) = Da a Issued -- - - - ---------------------------- ----------- p ��'" This Permit Expires 1 Year From Date issued ' ^.___ ---------•- ----------- all the work o construct and in is hereb made to the:San Joaquin Local Health District [narn e ermit t and existing Rule Land Regulations tein Applicationplication is made in compliance with County described. This appy .�j --------- described. I: C ' L4T - W 1Q - CENSUS TR _ ` - t t . .JOB ADDRESS/LOCATION a 5----- ------- -_ Owner's Name f C� L L�N�-- L#7--- I +6 S_ _577 CitY 1 l Address ------------13-t? -------- ------ Phone ------------------•------ Contractor's Name ----�-wN-a�------------------------------------------ _-.License # -------- ----- - � i+ Commercial ❑Trailer. i 1Residence ❑ Apartment Hou installation will serve: Motel ❑Other ----- -------------------------------------- r� l�[VLot SizeC>�--•---- � I Number of living units:_._rl -- rt;]umber ofCb`edrooms ____ _____._Garbage Grinder l Private --------------------------- ETClay Loam ❑ f " Water Supply: Y -------------------------------- -- ------------- 1 Public S stem and' name - ' Silt Clay ❑ Peat❑ Sandy Loam Character of soil to a depth of 3 feet: Sand`❑ ❑ A}^ i .:t r-� .:<�❑ Fill Material _lam-! If Yes. type --- - Adobe-❑ ! k k Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be played on reverse side.) -� S �NEW INSTALLATION: (No septic tank or seeps a pit permitted if public sewer is available within 200 feet,) i Size----t �.,X ---- �; .L quid Depth SEPTIC TANK' a" PACKAGE TREATMENT [ _____ _________ __•: Capacityz TYpe � Iq Mater(cil'Crl �� T�No.�Compaents ; c. P; Line _- �:•-.•--•- ' I Tota Distance to nearest: Well --r---- ----------------Foundation i f s I Length ----Blt ----------- ----- i �� _ Length of each line____ __. s LEACHING LINE . [ No, of[Lines .-_-- -- ---- !f -------_ 1F OC.-_ _ _De th,;6ter�Materiall,--- ----;.Mf y D' Box __ -- Type Filter Material _---- iP 1.�< .� _....- ' F. ,3 lot------=_-' priopertyLLine - � Foundation -- _r Distance to nearest: Well ----- Number _ I -_._-- I f Rock Filled Yes ❑ No ❑ k � i - �• _ Diameter ___-----__---- SEEPAGE PIT [ ] : Depth - -;-'--- ---- ` Water Table Depth --------------------------------------i>----- Rock Size . `O �ca , _ •---- Dis#anteI to nearest: Well ----------------- 1` =-• -Foundation-•_-�- '-'" f Prop. Line _.__.__...----•-- t .." Date ----- ,i ) i REPAIR/ADDITION(Prev. Sanitation Permit`# --------------------- -- SLR •------ -•- Septic Tank (Specify Requirements) --------------- 9' Disposal Field (Specify Requirements) a, i�_l i --- fia- - --f`- 1 -� .-:.- ---- �HI� v4 K � ------------------ ------------------------ -- - ----- -------------- . ------- - -1 -"-- (Draw existing and required addition on reverse side} 3 ` 1 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 Joaqu+n Local Health District. Home owner or licen- , l sed agents signature certifies the following: ps ' p y y person in such manner i "1 certify that i the performance of the work for which this.,ermit is;issued; 1 shall not em la an as to become ubj t to ork an's Compens tion laws of California,'.' 'I y Owner Signed ----- - ----------------------------- -- --------- Tide ------ (If other than ownerl }; FOR DEPARTMENT USE' ONLY ��jj ` --------- ---------------------------------D.AT.E____(�-- -- - -D-- t. - O r------ - - -- APPLICATION ACCEPTED BY�.____� ��-- - _^ __ DATE _ � - °�- --- --- • ------ - -- BUILDING-PERMIT ISSUED _ .. c - -- = r #� �J -�-• ADDITIONAL COMMENTS _ s --- - `- ' ` L=- _ � f r ----------- -- -----------_ Date ------------------------------------- -- ! Final Inspection by: ------------------------------------------------------------ SAN -• - ------- ----- ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Revt_ -