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E FOR OFFICE - APPLICATION FOR SANITATION PERMIT -� - ------- ------- (Complete in Triplicate) Permit No """ ----------------------------------------------- ---------- _________ This Permit Expires 1 Year From Date Issued bate issued " "q7 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: /-/975P C H _e� JOB ADDRESS/LOCATION . ___l.??' o----LS "-----0. ---- P - �1--On/----/ cS�-rj _._CENSUS TRACT -------- --------- Owner's Nam//e�� ._LO r_ .------43!?�nC---A/9-RT---------------------------------F-------------------Phone ------------------------------------ Address Tq �-------- ��- L.- e-- --. City -"�--"'4.-»-f-- �� -•------------------------ Contractor's Name _.__-t'- t-1 �`� ___ L1_ _''��y ^ -�-� - -�---�--�----�-- -- ---�---License #�.�.�� 5------- Phone _ Installation will serve: Residence 94-Kpartment House-E] Commercial❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units -"_ -1------ Number of bedrooms _;,,_____Garbage Grinderye}__-- Lot Size -S_ '�____"______ _______ Waterp t�r:.RiuNc System and name ------------------------------------------------------------------------------------------- ----------- -------Private (?/` . 1 r Character of soil to a depth of 3 feet: Sand Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �r PACKAGE TREATMENT [ I SEPTIC TANK J 100' Size-J'>(_ /f �� . _ ---------- Liquid Depth --- --_J -- ' Capacit _____ Tye __ Material'nd ? No. Compartments -- --------- Distance ------E}istance to nearest_ Well _ -Itro---------------------Fouundation ------------- Prop. Line -----3-----:---___-- LEACHING LINE [<J'No. of Lines -__- ► _ --------- !Length of each line----9e____________ ____ Total Length ,__7__ ............ y t D' Bbx ---I------- Type Filter Material A_t< -------Depth Filter Material ----- _19----------------------------- Distance to nearest::Well ___ _ ____________ Foundation ____)V-------------- Property Line ____�k-____-. SEEPAGE PIT [ +-I Depth ;Tabr �h Diameter Z_X_` ___ Number ______/______.__________ Rock Filled Yes ®"No 0 i Depth- -----`---�--------- Rock Size J ----- _ Distance to nearest:,Well ____ C ._.__ -------------------- __1.-----t__ Prop. Line ...................... REPAIR/ADDITIONiPrev. Sanitation Permjit#�-------- ----------------------------- bate ------- ---------- ----------------- Septic ------- ) Se tic Tank (Specify Requirements) � VF? '��---� � �---! Disposaf Field (Specify-Requirements) - Wit-`---- or►�i_E' -F' _____ ODt=D_____ 1Ri t HTlvrtl _(�� _iF{��3 _ -fT__C�sJt-Q 3E ct Ft_-----ED_._ Cr-��K�D-----€V-ER-'-- 20-( -F--- cT_ lil(f} -- -----Fair -'t i3> �E Tau � �c< --'t--FR ._-c -_5r�-r_ [Draw existing and required addition on reverse side) SMR A!7- WA--15 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 following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to,become subject to Workman' om sati.on laws of California." Signed (.)'-J -- ---- ---- ----------- ------------ Owner B.Y ------=------- �' "� l�'---------------. Title than or) FOR DEPARTMENT USE ONLY PPLICATION ACCEPTED BY ----- r Pl-.a----------- ------- --- - ---------------- ----------- - - ---- DATE./---,-'.-- ZI` 6 y 'BUILDING PERMIT ISSUED DATE ---------- -------------------------------- ADDITIONAL COMMENTS TpN --- T ------7 Olt- LN_!-1=T p-QT --------P P --- ttf.4_5 ji_D!-4f E�_7---- 471 R-HiQ-----Cn-pagri--T/>-"------T ---- ------ ---- -- _ __0------6_6LSA'--------------------------e0e-------------------------------------------------------- -------------------" - ---- -------------------------------------- ---------- ---- ---- --- -- --- Final Inspectio ------------.Date _.._. Jul . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M