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rVK VrrikX- e APPLICATION FOR SANITATION Pew .................I.,..................................... i (Complete In Triplicate) Permif'Na. .... 5.. ...., fDate Issued ...1017 ............................. .......................... This Permit Expires 1 Year From Date Issued . r Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ThIs-oppikation-Is-made-in-compi lance-with-County-Ordinance-No.-549-and-existing. Rules and Regulations, JOB ADDRESS/LOCATION`�'.('-?IPQ'Z.0..... vV V?11-Pj.C6.. ......................:.CENSUS TRACT �:�L-... _ N IDE .... .....; , ` Owner's Name ..R...... ...........�-----�-.._........---......__,�._._............................----..........Phone -----•----•-----• Address ..... ' .. --JS11151 ---... Ih :.... City .... 1 = ..M. a........................................... n , L Contractor's Nasse .P�.` .. ...........Licedse.# ., �. Phone .......... ................... Installation will serve, ,Residence partment House 0 Commercial❑Troller Court Motel ❑Other........................ .:. F r ; Number of living units:___. _..... Number of bedroom"a .��........Garbage G_rinder`. - __.. tot SixeS�.....................................:..... .._ Water Supply: Public System and name J:t9UR�� -D.------/1�f}nro -_- ._...-:. ....Private ❑ .... .... .................... Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat E31 Sandy Loam ❑ Clay Loom Zj,' Hardpant❑., Adobe[]LFIII Mcterlol A/-jP... Rif yes,type.. ... ........... Plot plan, Bowing size of lot, location of system In relation to wells, buildings, etc. must be placed 'on •reverse slae.) i NEW INSTALLATION: (No septic 1 tank or see a pit permitted if public aewer.is clvaNable within 200 feet.) f x r PACKAGE TREATMENT [ ] SEPTIC TANK 51ze_ X./Q.X_,.-. :..._..:._--- Liquid Depth ..5.................... Capacity l� ©�--_-- Type R.— . Moterlal�C.*MI~No. ~Compartments 2-: ------•• ... ........ . �f 4 foundation 1 :: ................. stance 10 nearest: Weil�:::...... ................ f. - -`. . Prop. Line . iEACHING41NE No. of Lines ....�.. .._. Length of each line.... d ; X Total tength /000 Q ,�� 'D' Box!r-.!S- Type Filter Material .i:l0.G. .e_,Dep?h Filter Materlal ,`.�.,.Je?................ ...... ....... Foundation .... • Property p-erty Line ...,.�... .F/4-,, R Distance t'o nearest: Wel# C .......... ...�.�..... ....... SEEPAGE PIT [ Depth Diameter ................ Numbers.L......................... Rock Filled Yes ❑ No ❑ E Water Table Depth -_--•-••--•-••-•...............................:Rock Size ............---••-........-...__ r ,..:� Distance to nearest: Well ....Foundation .................... Prop. Line ..................... . REPAIR/ADDITION(Prev. Sanitation Permit# ... Date .............................?•--•I Septic Tank (Specify Requirements) ....................................... ''.............'.'._.... -....... _ ... .........�_....._....................- _ _ .. .... Disposal Field (Specify:Reqilrements] ' i .................. •-----•••--- ............................................... d ,JV-.1 4 . -V 1. A }�JI-),t!1`1 .)..... . i 9 f +: Draw existi.ng.and_required addition an reverse.side 1 hereby certify that li.-hove prepared_t_his appilcatli n". nd-thof-the-wark, will be done in accordance with San Joaquin- County Ordinances, State Lowseand Rules and Regulations of the San Joaquin Local Health District. Home owner at Ilcen. sed agents signature certlfles ths.foilowing: certify thai in th performance'of;'the rk for which this permit is Issued, I shall not employ any person In such manner as to beco sub to man's ensation laws of California." Signed r } gn .---- :.. .._. ...-• . •-----------.' .......................... Owner By ................. .. ._...._..._._.. �' - . ,( -77itls `>'::: ..:..:.. `,..'.:_...�"_-' ... .... - .._._ -;r � ... ._....._jlf.other.than_ownerl �' ' `4_-_t ' �` u `'"' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ....... `'{'a�.��............................ DATE ....7-_-757 ........ ..._.._•------•............. ..... BUILDING PERMIT ISSUED ........................................................... .DAYE_�-.......................................... ADDITIONAL COMMENTS .......... .... ................................................"--......_......... - ---- {--------------- -----•.................................... :........ .............. ......... _.... .................. ;. Final Inspection ............Date .... .....'�................ ....... .... { 13 2h '6 • ` i SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M