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FOR OFW APPLICATION FOR SANITATION PERMIT a Permit No: (Complete in Triplicate) ( j This Permit Aires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Ialth District for a permit to construct and install the work herein described. This application is made in compliance wi County Cdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _16-73-57S -RPS -i ----------------------------------CENSUS TRACT ----- ------ ........... Owner's Name --------Fb-------t417�i-�Jn&G. . E _ _Q-------Phone 3--59-11-9----- � p , Address ---------16.73-57--S------- --BI-11-PQ -------- city 11�-Tc0. Contractor's Name _-__.O_WNj_E.I�----- ____ nW__0P1 _�-,SO7 _ _ -------License #417-5-80----- Phone 9.23-524.7_- Installation will serve: Residence ❑Apartm it Housef],ts�mmercial ❑Trailer Gei 2r� Motel ❑Other _ F ------------- Number of living units:----I------ Number of bedroomsj[ Garage Grinder -X_0__ Lot Size _^CRjFf}6r — Water Supply: Public System and name ---____--____________ _________-_____t------------------ -------•--------------------------- -----------Private Q� Character of soil to a depth of 3 feet: Sand❑ Silt Clay Peat❑ Sandy Loam (Clay Loa [j Hardpan ❑ Ado e ateria �_ If ,ese Y type - ,`5RN-h----.` M (Plot plan, showing size of lot, location of system i -''relation to wells, buildings, etc. must be placed on reverse side.) p (No septic tank or seep i;�` NEW INSTALLATION: rmittedif ublic sewer is avAilable within 200 feet,) Ti PACKAGE TREATMENT [ ] SEPTIC TANKhi ' e :- / + �_ sevt -Liqui .-fig Capacity _/Z0_0----- Type material__Cfl .r� 'No. Compartments _-';____...._._.. istance to nearest: Well --------------- 0_.--+_-__Foundatio�i �-_� ! � Prop. Lind _- . -� Y � LEACHING LINE Na] of lines ______, -___.___ Length of each line-______ _-______- Total Length --_J ............. i 'D' Box __ 5_ Type Filter Material /?P4K----Depth (`Filter Materia-_` i IF Distance to nearest: Well -______J_�__-_'+' Foundation _-. -_ -------------- Prop me '._-_ . ................. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number .---------------------_------ Rock so No i❑ ,,Water Table Depth ------------------------------------------------Rock Siie Wtance to nearest: Well __.-.._-____--------------------- ---Foundation --- �R --- Prop. Line ...................... REPAIR/ADDITIO0revd * n Permit# ----- --• ��y�'t __-_ _• ___________-___tw t --------- Septic Tank (Specify R quirements1 --------------------------------------- - -----------------).-� -----.- _ 1 _ � Disposal Field (SpeciRequirements) --------------------------_ -----------------------•-- -` r ---------------- i (Draw existing and required addition on reverse side) ; I hereby certify that I have prepared this application and that the work will be done in accordance wit"an Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home aJ ii or licen- sed agents signature certifies the following: =� "I certify that i the perfore of the wo k for which this permit is issued, I shall not employ any person in such manner as to bec ubjec n's he sation laws of California. Signed - Cic -- --- --- --- --------------------------------- Owner BY -------------------------------_------------------------------------------- R.Q. titleA-5--__ 1 (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ____/ �_ 'F'� _ -------------___ --_ -----------------------------------------------------. DATE ----/-�'---�7--E ---------- BUILDING PERMIT ISSUED ------- -------------------- DATE - - - - ----- - -- - ---- - - - - ----- - ------------------ ADDITIONAL COMMENTS _. • _ �_-_ / ___ r �---------------- =- R -- ' !I t )rt 1 t\ ___ - __ -_ F 1.-\,4 --- ----------------------------------- ----------------- -- -------- -- - --- --- -. _... _. _. _ -... Final In tion by: .-_ _ Date _- . t/__ �`F = -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M