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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............................................. {Complete!n Tr#pllcate) 7� _.............._..... Permit No. . '..........._...... # •. This Permit Expires t Year From Date Issued Date Issued t Application is hereby made to the San Joaquin local Health District for a permit to constreict and.:lnstall the work herein described. This application is made in compliance with County Ordinance No. 549 and existing ,Rules and Regulations: JOB ADDRESS/LOCATIOV ._-5,5� ........ ......................................CENSUS TRACT .-•-•----........ Owner's Name _____________ 'L.-- -c . �.L-_ 'C,w l` -�1.._ .`� . ...Phone .j3. .... .� .. Address ._.... ------------ 9, � U``R "----- ............city -<........................... ............... ------------ ............. Contractor's Name ..---------- ��--�•� � .........:........License # ---- Phone ....... Installation will serve: Residence Apartment House C1 Commercial OTrailer Court C] --r-..�-• -� - Motel[]-Other: . _ _ ^^- Number of living units: _... Number of bedrooms ---3' Grinder O CU _ - Lot Size l___.... a.................. _- - y Water Supply: Public System and name ......A.(,4.0.0 C.-<,),a—r� ..._._.....................r---..............__- _ _._...Private 0. Character of sail to a depth of 3 feet:"' Sand b Silt❑ "Clay 0 Peat 0 Sandy Loam ❑ Clay Loom ❑ t —Hardpan'Q . AdobeIA-`Fill Mpterlal ............ If yes,-type............... ,,--T#Plot plan, showing size of lot, location of system in reldtion to wells, buildings, etc, must be placed on reverse side.) ' NEW INSTALLATION— r_(No septic-tdrik or seepage pit permitFed if public sewer.is available within 200 feet,) PACKAGE TREATMENT [ ]- SEPTIC'LANK . Liquid Depth ' Capacity ............. Type ;:-'•: - Material..-------------------- No. Compartments -•.. ................. Distance to nearest: Well Foundation ....................... Prop. Line LEACHING LINE [ ] No. of Lines W = = Length of each fine.. :...:_... Total Length .............:.............. S ; 'D' Box ---------- Type Filter Material ....................Depth filter Material Distance to nearest: Well ___._-___•.............. Foundation ................ Property Line ......................... Depth .Diameter ......... ____________________ _______ Rock Filled _Yes-:[] No Water Table Depths:...}::-•=-•-_-•.-----•------------------------Rock Size ....•-..----•---. ............. i ...... G :- Distance toTnearest: Well- ._ :=* :•=_=-•__- foundation Prop. Line ......... ...._......_....._____ REPAIR/ADDITION(Prev. Sanitation. Permit# --------------------------------------------- Date --••--____--__--...._.......___-_-} 3 ,DSeisptoicsaTank (Specify Requirements) .__. . .Z ...-__ j . . Fieldmf_ _.x --------------------- ........ - ........ ----•-- ------ ----- - e _(Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the•work,will--be-done tin--accordance-,Ai *inn Jooquift' 1"4 County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner or Ikon- f. 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. i as to become subject to Workman's Compensation laws of California." Signed _.. ------------------ Owner 6X�. .___ O r By ---------------- •--- Title ` -------_----•----,..•-- (if othe a owner) FOR DEPARTMENt USE ONLY APPLICATION ACCEPTED BY -------- ----- DATE ......+� �..-�..5�__76 y`} BUILDING PERMIT ISSUED ------------------------------------ ------_--- - - ---------- --------------DATE ........---------------•..__ ....... ADDITIONAL COMMENTS ..................................----------- ------------------------------------------------------------` ----------------------------------------------- ------------_______________ ----------------,r.-_. ._...: .................. ___. --____ ____-_-.-.-.__.___--__----__ .__-_-----_I——---_-------_____----____-._-__--_. ____ A., •' ________________________________ _----------------------_------____------___ _________ ____________________ ..___-....__-____.--1....................__..__--..__..-.............. .............. ........... _________________----------_--------_________ _. ___ ...-.................................. --.--____-,__-_ _ _...__-_. __... Final Inspection by: ---- - - - - ...................................... Date �/ ..r� EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT $