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FOR OFFICE USE: APPLICATION FOR. SANITATION PERMIT ...... �° TS (Complete in Triplicate) ............................ .'-'--'-' �d ------ ........................................ This Permit Expires 1 Year From Date.lssued Date Issued 111..............1., Application is hereby made to the San Joaquin Local Health,District for Pp Y q permit to .construct and install the work herein described. This application is made;in compliance with County Ordinance No. 544 and existing Rules and Regulations: it JOB ADDRESS%LOCATIO � .4....... r' .-.. -. ...........CENSUS TRACT .......................... Owner's Name ........... . .... .. Phone ......................................•-'-•--•. ------�� .................................... Address .._.__� ............. City ............-....................................... Contractor's Name .0 �mA "-----.license # .6t.:�o.-7� `r Phone . '10-1. s Installation will serve: Residence KApartment House❑ Commercial []Trailer Court �] Motel ❑'Other ........... ----- ----- " -----,- g -.37- ... g "�" Lot Size ...a�'w _f .e'--ar_9.... .. Number of living units:..../_. Number of bedrooms Garbage _.. ..,,•. Water Supply: Public System and name .......9-.1.1! 1111.C,u�r�G{ ;- ------• --------- ...................................Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loom ❑' Clay Loam ❑ Hardpan ❑ AdobeFill Material - ... •-- If yes,.type ............................ (Plot plan, showing size of lot, location of system in relation to wells, building ', must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public ewer available within 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK'S ,ice!'/S ' � -- ..-._.._-Liquid Depth ............... Capacity .... ..... Type M }hri I-- ----- ............ No. Compartments- -------------------- Distance to nearest: Well .__ ..-Foundatio+n .. ..._...., .. Pro Line.,--------------- '""LT; CITNr; LINE No. Line ✓..�. . . ..- Length of ea fine .... .:......_.. Tata) Length ..� �` •D' Box ...� - . Type Filter Material .,Depth filter Material _.`. ......_..........................tA £r _ Foundation .Distance to nearest: Well _...�1�-- ... ':_-._--: Property Line _4.................. o f Depth -, Diameter Number .... .......:. Rock Filled Yes `No,C90 "'11 p 1111. t, •-... GJ.X yC!0 Water Table Depth _1;111... .. ..................Rock Size!-.,,,.v. .._...._............ i i� 4 E t Distance to neare t: Well . ..... -. _.,. l --.:._-...: Foundation :-.l _ -... Prop. Line .k?x _._:._...... 14EPAIII/ADDITION(Prey. Sanitation Permi }# ...._....._ Date _.. a..z.7 .... I 1 y[.� `Septic Tank (Specify Requirements) �. ------ -�- '- '---11/11 --"----'------•- ------'---- .......-..............:1:... 1111 1111. . ................ Disposal, Field ISpecify Requirements) ..._._... ,... F . F -------------1111 .............................. ,--. .... . --. .-- ... ... -- -------- .....-----......-......_.._._......... ........ ° ................. 1111:-........ ..... ........................................................1111..__111.1... ..... ................................. . IDrgw a ist ng and required addition on reverse side) I hereby certify that I have prepared this application and that ythe work will 4* 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: "ll certify that in the performance of the work for which this permit is issued,.) shall net employ any person in such manner as to become subject.to Workman's Compensation laws of California." Signed ...............:.. ............... Owner f By .._. .60 1111 ;-• title 1 111. Iff other than owner) FOR DEPME T"USE ONLY 3 -- DATE 10.-li--.ST...-------- APPLICATION ACCEPTED BY .............. ---� .. ."` - .._. ..- ....�-�--'-' BUILDING PERMIT ISSUED 11`:11 ..........-•------...-..----1111 - .-..-..DATE ......................................... ADDITIONAL COMMENTS ..:....-'.......... ...........1111. -------- ------------- -"------.............. ..-•--"---•--........................_ ------------------------------------------------------ _:.. - ----'-'--- ---- --'-- ---- .............. ..--•................11...11.................... i Final Inspection by: ............. ---'F --------------' Date _...................._ - ----•-'�---• -'- -"--'--------------1111--'-----• • - - --......._...--------- SAN.+JOAQUIN LOCAL HEALTH. DISTRICT 4 13�2'41.'A>3 j?o,. +sem 717? 3 u �'