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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. --------------------------------------------------------- rom Date Issued Date Issued Application is hereby made to a San 4441L 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: M Tri} f JOB ADD SS/LOCATON .__..- - - --, ------5�.---_AI`s' ea_X_7_ __Utl,4y---------CENSUS TRACT ---- 1___--- Owner's Name i�'/�-c= k Fe S Phone av`- -3v� S- Address ----------- �'� 5�/"l_ Y_3 ->-__ ------------------ Cit Ccs COYi /gyp /L- /�j�a_o,hey Wit' License # _�'6 Phone 3 V.21` Contractor's Name ------- = �------ - ....... --- Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:------ ____ Number of bedrooms __;;�------Garbage Grinder .----------- Lot Size __- O O__C>b i Water Supply: Public System and name .____ AI'c1f afy__.V'' L A �_ �t �-��_--'Vk°/�}� �� -private ❑ Character of soil to a depth of 3 feet: _ Sand K Silt❑ Clay ❑ Peat❑ Sandy Loam ® Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material NO--- If yes,type --------- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT. [ I SEPTIC TANK [ Size------�AA_>F__A---2-----_-------- Liquid Depth --`---.---_------------ "IN Capacity -1-AD-0.... Type p'Y-e-6")5-TMaterial--_c6N__G.__-. No. Compartments IZ--...--..... f Distance to nearest: Well ----- —'---------Foundation ---/0-------------prop. Line ----- .............. LEACHING LINE No. of Lines __.__--..21_____________ Length of each line_-__-__70-------------- Total Length ---1.`9�............. 'D' Box ----/------ Type Filter Material --- - Depth Filter Material --------ate -� S' Distance to nearest: Well ---IVC-- '�:-_ Foundation -____/Q------------- Property Line -.--_ ..---........ SEEPAGE PIT [ ) Depth --------- ---------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size ----------------•--------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------_----. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --.--.--------------------------.-) SepticTank (Specify Requirements) -----------------------------------------------------------------------------------•------------------------------------------------------ Disposal Field (Specify Requirements) ---SE�a7LC__ 5�57FM --- _---__-- =- --- ---------- _- 7779-� -- -------------5�R�� T ;�?- ---- ------------------------ ------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ---- ------------------------------------------------------- Owner `�� - --------------------- ------------------------ Title ------G-Q1YT1 (If other � er) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- _ _. %,----------------------------------------------------------------------------- DATE ----77. _27-__7/------------- BUILDINGPERMIT ISSUED -------------------------------------------------------------------------- --------------------DATE ------------- --------------------- ------- ADDITIONAL COMMENTS _-_._, ,----------------------------- - --------------------------------- ----- ----- -- ----- -- --- ----------------- - -- - - - -------------------------------------- -- -- ------ -- ---- ---- Final Inspectior�'by--------- .E'` � % f C= Date � '� .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M