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FOR OFFICE USE: [ APPLICATION! FOR SANITATION PERMIT Permit No. .-. (Complete in Triplicate) sS-/3 6 ........... . ........... ---- - 7S .............. This Permit Expires 1 Year From Date Issued Date Issued .................... Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein { described. This application is made fin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION......./ �I.._._.�A 1` Y.San' PASS.../ c/ ................. CENSUS TRACT ......��. . � :.::. �Y.'FF.�T Owner's Name ._...��pT...4W............ •-----------• ........................�YQ`......_.._.....Phone .............................. Address .... '� aT�ic .... City ` a Contractor's Name _..... h__.......a !r...- -----.P.`y.......... ......I....................License ,•I�14e-5 F� Phone �.� Installation will serve: Residence JVLApartment House 0 Commercial ❑Trailer Court 0 Motel ❑Other ............................................ l g Grinder ....... Lot Size ..L��"/3av�5. F...:..._.. Number of living units:.._ ..___... Number of bedrooms ._� Garbage Grind. Water Supply. Public and name .........................................................................-..,...----...----• Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ -Peat❑ Sandy Loam C& Clay Loam ❑ Hardpan Adobe. Fill Material+.. - -..:Af yes:type= ::.: - -�-�•--� - - - (Plot plan, showing size of lot, location o€. system n relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK-[ ; Size-*yI IC `I, .......... Liquid Depth ...y_'.................• . 7isto acity ..1 a. .� Type hY ..6A_s T Material A79&& ,----- No. Compartments !;k............. 9' ince to nearest: Well .......4P.......................Foundation _... .... Prop.Prop. Line .:r�� ----------— LEACHING LINE 1441No. of Lineall......A.............. Length of each line....../.4O_:_........... Total length .;?a�.......:._._._.. 'D' Box ..... h---- Type Filter Material JQoG --------Depth Filter Material --- d.,....................... I . Foundation .5"D .......... Property Line 2p Distance to nearest: Well ..b'�..__.............• .............. ---------....---.....---� SEEPAGE PIT [ } Depth I ..�...-.�'"--------.. Diameter ----- ---------- Number --.--....---...._-.--....j� Rock Filled Yes ❑ Na ❑'1 r � Water Table .Depth . ......................Rock Size o .................. ..........ir ....----...--_.... Distance to nearest: Well ..._...._... .....................Foundation .... ::. ....___. Prop. Line .... .............. REPAIR/ADDITION(Prev. Sanitation Permit#_.................... ...................... Date ..........•-•.--.....t... ...... Septic Tank (specify Requirements) ................................ •----------• ......... Disposal Field (Specify Requirements) ------------------ -- �+ _ --- ............ ..............•--.....---------.....------...------ --------- .......... FFPLAIE _ - � - 9 .. .. _ . (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 licen- sed agents signature certifies the folio'wing: r "I certify that in the performance of the work for which this permit is issued I shall not employ an P � P y Y Parson in such manner_ as to become subject to Workman's Compensation laws of California." 3 Signed * ,94r-6!y y..SQ!�. Owner BY ... . litie ...ner)..........................••.........._ (If othe�t owner] 44 FOR DEPARTMENT US� ONLY APPLICATION ACCEPTED BY .....- — ` ,�--- - ----•----------------•-__..----••--••-•-----•----------.._......._.._.... DATE .-------�.....�!��-��-l'----- BUILDING PERMIT ISSUED ................ �...........------....:... ..................•._........... ..........................DATE ------ .................................... ADDITIONAL COMMENTS ...-:::.... ..__._._...... _r ................................. ............••----------- :.. C/ . --- . ... final'h�spectio& y:, :.: ' [ :.::. _ . . '::R:.::----------I.--- ----- ••..�. .j �---- ..r. 4_ ......Date ... .... ......... '................................ SAN JOAQUIN LOCAL HEALTH DISTRICT A E. H.13 24 1--68 Rev. 5M