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y - Y 6 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------- - Permit No. - (- ----- -=-------------------------I------------------ (Complete in Triplicate) --------------------------------I--•----•--------------j- . ~� This Permit Expires 1 Year From Date Issued Date Issued 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'made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 3-60-0-----c FV-----/Vcv -----f-- -C�----- /WT-CA-:-----CENSUS TRACT ----- Owner's -•- ------- ;^�� ----- - -/ -- ---------------------------------------=- ------- 5� Owner's Nameff.�./�sIL?_J��S------t---�: l -----------Phone -------- 1 �' . Contractor's Nat t? f'i -'Z------rx r- ------ <<�-( y-+�4� ------------------------------------- ------ Address -�----- ------------------------- City -©�-------- e ` -G._- f f� License #( �� - Phone Installation will serve: Residence �?Apartment House°[] Commercial ❑Trailer Court ;❑ Motel ❑Other - 11YGL ----13E{)-[id0-M}_ e A BI NS I WASH H0053` Number of living' units:.-- --.__ Number of bedrooms __ -_-.Garbage Grinder ------------ Lot Size -.A1��-&�.........._.. Water Supply. Public System and name -------------------------------•---------- --------------------------------------------------- 1----------Private B PP Y- Y - Ir i Character of soil to a depth of 3 feet: Sand' Silt( Clay' ❑ _Peat❑ Sandy Loam ❑ Clay Loam ❑ { P _. ❑ ❑ rial --Al®-.If yes,tYPe`.' = --=------------ Hard an �4dobe Filf Mate _ I � (Plot plan, showing size of `lot, location_of system int relation.to wells; buildings, etc. must be placed on reverse side.) W 'Ah IrN NEW INSTALLATION: (No septic tank:or seep a pit permitted if public ewer is available withi 200 feet,) °V PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size------------------------------------------------ Liqui Depth -------------------------- O .Capacity -------------------- T pe -------------------- Material-- ------------------- No. Com artments ---------------------- `bistance to nearest: - II -------------'„r-w-:- --__-_--- --Foundation ---------------------- Prop. Line ---------------------- LEACHING LINE [ ] No. oft Lines ----------------- ------ Length bf' ea'ch line__ ----------- Total L ngth ------------ i•-=D'-Box ------------ Type Fil er Material`_`, -J------------- epth Filter Material ----- ------------------------------------ Distance to nearest: Wel ------------------------- Foundati nPro a p ty - -- --- -- Line -----------•............ SEEPAGE PIT —Depth -------------------- Dia eter`---_--_--_--_---Number ___- -- Rock illed Yes ❑ No i❑ f Viater-'Table Depth ------- -- --- ck Size --------------------------- ---- Distance to nearest: Wel -------------`---- --------------- ^ undation -------------------- p. Line ---------------------- 1 REPAIR/ADDITION(Frau. Sanitation Permit# ----- .--------- ----`--:_-_---------------------- D. e ------------------------------- Septic _____--_------------------- Septic Tank (Specify Requirements)' :1R- t {S - F� M w z--0OAL -- - - 0 v Disposal Field;(Specify-Requirements) 0 ---- ---------Wt-Q-�------ --- _� L E S r_ =M ) j ------ -- C{. L . ----- f (Draw.existing and required addition ton reverse side} 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: G "I terrify that in the performance of the work_.fo.r.which this permit is"is`sued, I shall not employ any person in such manner as to become subject to Work a's Compensation laws of California.” Signed S +--- ------ Owner By ------`/_7- ------- Title - ---------------------------------------------------------------------- - ---- ---- - s �-r �: (If other than owner} FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------FO,K-----f--YRS:---------- DATE -----y`23 70---`----------- BUILDING-PERMIT ISSUED --------------_ = _ f - _-__- - = QATE... ----------------------------- - :: ` ADDITIONAL COMMENTS { t - 11wL--.'- -------,4------yp0--- F1 ----- --1RQola-TANK _Tf1L1�y- W_ l`��_S _N! _ -ilEVR FiELf4CE .M.Eh]T...1 ....-STi-r,L_ 1 T MPD.f� - -------1 I S R tY1HX lT`^ rvl +f - ifWn tr FRt E -- -3 Z4' Final Inspecti Date ------------------ --- ------- ----- - ------------------------------- E. H. J IN LOCAL HEALTH DISTRICT �� ' E. H. 9 1-'68 Rev. 5M