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FOR OFFICE USE: ...........•--------•.................................... APPLICATION FOR SANITATION PERMIT7� QST ...........................:_......._.. Pe {Complete In Triplicate) rmit No. ...._._-.-.......... This Permit Expires 1 Year From Date Issued Date Issued .. .1 ........ 3 - Application is hereby made to the San Joaquin Local Health District for a permit to con:trust and Install the work heroin described.4his application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... �.�7 �'c ....G�.Q.�/CC�c - SIS/ o�c 1)'« Xv c'...,.......CNSUS TRACT ......... ................ , Owner's Name . ..l� / c� Gv//e G \ �, Phone ,.` 7. !?,O/..1............. ............. ,........--••• •-........................I..... Address S/S'/.. .c ��..... 4 Vim.. ........... ..................••.......city .�5�`. ...... ...e....... ...... Contractor's ..........�......A --------------..Name ....License # ZT.Y3.,yj_..... Phone `�� 96�.7....... I ��tiS_..--• � -. Installation will serve: Residence❑Apartment'House C] Commercial ❑Trailer Court ?.w® �o Motel ❑Other... _ Number of living units:—..._-_.. Number of bedrooms Garbage Grinder ............ Lot Size ��! + Water Supply: Public System and name .................. ....... ......Private ❑ { Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam p Clay Loam ❑ Hardpan ❑ Adobe ill Material ............ If yes,type ............... ............ { (plot plan, showing-size,of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: INo septic tank or seepage pit permitted If public sewer is available within 240 feet,) ' rr� I PACKAGE TREATMENT [ } SEPTIC TANK f ] Sized.. ..X: .::.....................::..... Liquid Depth .f r+`................... Capacity /.. 0 0....-._ Type '' _fir. Material.r--��tc,r�fr'. - •- -•--••--- No. Compartments .....7w-.......... � Distance to nearest: Well _____ .......Foundation .../_0............. Prop. Line ....... LEACHING LINE [ ] No. of Lines _......_4----------_ Length of each line.---.. ...... Total Length ............. 'D' Box ..../------ Type Filter Material ._-Depth .Filter Material ....../1�................................ I Distance to nearest: Well .-1/!@�7_------ Foundation ..../_-Q.............. Property Line ...hp.......... s. I SEEPAGE PIT ( ) Depth ...:mss. Diameter ...Y!F....... Number _........./_............... Rock killed Yes JW3"*No (:1 Water Table Depth ......................... ... ... -•--..Rock Size y.aC./. .. C Distance to nearest: Well -------- ...................Foundation ::%t.d..._...:. Prop. Line ..IBD........... REPAIR/ADDITION[Prev. Sanitation Permit# ....................I-------- -".._.:--`--'--... Date -------•.......................... 17 ,a Septic Tank (Specify Requirements) .-------_-----_- . ..-----••----------••-•--------•••••..............•-•••.._._...- _.... C Disposal Field (Specify Requirements) __-...._. - ---------------------------••---------------- -- ------ -•--•--------------•-•---------•---, -- I ••-•--------------- lDraw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dans 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 perf mance of the work for'which this permit is issued,.1 shall not employ any person In such manner as to becomes iect to orkman's mpens tion laws of California." Signets fi l By .. ......... ----------------------------------------- Xitle ......�� l 6sa of r f 0 e than owner) f FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE 7 - ----BUILDING BUILDING PERMIT ISSUED . -- ------ DATE ADDITIONAL MMENT .4.a.-._.,gyrus ._ ._. . --. ._._.._ }..._Y ..._, ..._. .r.4.,.. . _... _. .. _. +r :. '� ---d•---•- r ...__ --• .....__ ........... .......�_...�o -r --------------------- ..---- -- �.. . _ ._... s7�__.., -------------- ------- final Inspection by: -------------- Date -- ------- -- ---�_. -..- _ .. _ ._ EH 13 2h J.-68 !Lev. �...... .._ SAN OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M i