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1 FOR OFFICE AJSE: �: s APPLICATION FOR SANITATION PERMIT ------- - -------------------------------------- Permit No.lp� i (Complete in Triplicate) ---------------------------------------------------------- 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 ._;�_-��_0T2_.___:5-------OL-E_ _------------------- - _ -------------------------------- CENSUS TRACT ---------�'-•------___-- � rr ---- }(� E�- U Z 1��';'--------------------------=-------Phone ----------------------------..... Owner's Name ___-__1'"1_x--�__t_ Address ----------2-3.8173------ --------n -V-E ------------------- ----------- City ---- vr�-------------------------------------------- •- ----- Contractor's Name ---Q1A�NELr--------------------------------------------------- t ._.License #""------- ------ Phone ------------------------------ Installation will serve: Residence [�artment House,❑ Commercial ❑Trailer Court ;❑ V i� � Motel ❑Other -------------------------------- CS.r�f�.i"i�rE _ Number of living units:-3---- _ Number of bedrooms ----Garbage Grinder/Y.P__:---. Lot Size _e��A=",51-1�1_r------------------- Water Supply: Public System and name ----------------------------------------- ----------------------------------------- Private E]Character of soil to a depth of 3 feet- ��-,Sa d' Silt ❑ Clay ElPeat❑ Sandy Loam Clay Loam ❑ Hrar4p n ❑ Adobe '❑ Fill Material --- If yes, type ___________________________ (Prot plan, showing size of lot, location of system in relation to wells, g_ p buildin s etc. must be laced on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTICTANK'[ ] Size---------Z--------------------------------- Liquid Depth .------------------------- c` C acit Type ____jn _ aterial_ __ _ ____ No. Compartments ______________________ istance to nearest: Well _____ -----_. Foundation ______________________ Prop. Line ---------------_______ } No. of Lines ------------------------ Leh��f each line---- ----------------------- Total .,Length -------------------------- D' LINT; ] ; ,D. Box __________ Type Filter Mal _____�� Depth Filter Material ___________ _____________••---__,______... fDistance to nearest: Well --------- /-_______ Foundation------------------------ Property Line. _________-_____._..__ SEEPAGE PIT [ ] � � ,' Depth ________.__.______ Diameter ______-__. Number _______________�f __ Rock Filled Yes ❑ No i[] Water Table Depth .---------- •-- ---------------=--------Rock_Size----------- --------------REPAIR/ADp1T[ON{PreDistance to nearest: Well __._______ _ --------Foundation -.--_---_____i_.____ Prop. Line ...._____-______-•_-•_ i t,e �E; �., l v. Sanitation Permit# r --`-�"t'- D } --------------- ate �.:_ Septic Tank (Specify Requirements) ----i--- --------------------------- ` --------- --------------- --------- -- -----------------------------:-------------- p Y q_: T- x - P-}*I47n1A-�----------------- Disposal Field (Spe�if Requirements)! _.�1� �� _-.� --_- �Fpr-C-4----I-��1� .;-a s_u1'_ - n�_ n�.T-_.�. x�sr.�_ 1 - y --- --=----------- 1, € (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 liven- sed agents signature certifies the following: "I certify that in the performance of the wo or which this permit is issued, I shall not employ any person in such manner as to become su ect to Workman' C - ' o n 'o laws,of CaiiFornia." r - .- F. Signed �Y,D -- ---1-�--�----------- ---- ----------- Owner f I By ------------- --- ---------------------- Title -----------------{----------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I----�. ` = •5 N, ; L�,% N�s `_=xz ---------- I ` DATE l BUILDING.-PERMIT ISSUED _ Wim= M-- _ - -_DATE-=:- —----------------------- ADDITIONAL -------- -- ------ ---- ADDITIONAL COMMENTS - --------- - ------------------------------------------- ---------------- ----------------------- --- - -----------------------------------------------------------------------------------"-------- - ----- _ -- -- - - - - ,! f` Final inspe�ctio�; -Date -_.-€ _ SAN JOAQUIN. LOCAL HEALTH DISTRICT l E. H. 9 1-'68�Rev. 5M