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FOR OFFICE USE' + 110APPLICATION FOR SANITATION PERMIT --------------------------------------------------- (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin.'Local..Healthr.l?istrict for a permit to construct and install the work herein described. This application is made in'�zomplionce with County Ordinance Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...../55'2_3_5 p ry �" _Z_ - ------b__I3_ �C�_` _-- - --`------MIrACENSUS TRACT ----- ---••------.---- Owner's Name ............ li ©©9 }� --------- -------------------Phone --9-2-3-------- Address ........ 7-3-- F. -----`5ou' t- ND q -------Rt-a-------------- City ---- ---------- -------------------- ------ Contractor's Name _ 1QM- 5 -15-T.S----------- -----------------License # -2-5/ ' _ _ Phone ------------------------------ Installation will serve: :Residence [Apartment House-E] Commercial ❑Trailer Court ',❑ y Motel Other ---- ---- f ❑ - Dr Number of livingunits:_---_------/---- Number of bedrooms __5_____G__ _Garbo e- Grinder w _._S ��QQ ------ 9 �----- Lot Size - - -;/---------------------------------- Water Supply: Public System and name ----------------------- ='---------------------------------------------------- -----------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam &,--Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material _Iv0--- if yes,type __________________________ (\,, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1 NEW INSTALLATION: (No septic tank or spepa it permitted if public sewer is available within 200 feet,) N)PACKAGE TREATMENT [ ] SEPTIC TANK'[ 1-F SizeJ_X j_---�-,6-------------------- Liquid Depth ----------------- (0 Capacity ,/5_Q0___.__ Type- AB_ Material__CbNCK- No. Compartments ----- . 'stance,.,to nearest: Well ______�O,_€`�_______ __..Foundation __,�Qy_+____ Prop. line --- LEACHING LINE No. of Lines _ �_--�--- _ -_.. Length,.,of each line---711------------------ Total Length ---- -------- 4 OL, 2777-1. Length, —.�... Z' k./p t e 'D' Box _ _ Type Filter Material t'_J_�-CK___Depth Filter Material ______/_ _-------------------------------- Distance - . .µ q _ ff ! ------- -----=--------------- Distance to nearest: Well ___ �__" __ Foundation ,!_ t 7t7------- Properlll 6ne --5__'-"" ------------ SEEPAGE PIT [ ] Depth -------------------- Diarrieter --------- Number ---------------N._.------ Ito& " 111� Q 'Mo 0 Water Table Depth ----------------------- -- -------Rock Sites --------------------------------- Distance ----------'----'---------•----Distance to nearest: Well ------------------- -------------------Foundetion -----------------0- lkgp. Vow ---------------------- RMWfAOOtlF (Prev. Sanitation Permit# -------------------------- --- -- Date ----------------.-----------------1 f� Septic Tank (Specify Requirements) ------------------- -------------------------------------------------•----------•-- ----------------------------- Disposal Field (Specify Requirements) ---••------- - ------•`--------------------------------------------------------------------•--------------- { ------------------------------------I------------------------ f (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will Abe done in accordance wifh San Joaquin County Ordinances, State Laws,'-and Rules and Regulations *f-the San-Joaquin Locah;ilealth District. Home owner or licen- sed agents signature certifies the following: h "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's Compensation laws of California." 1 SignedOwner -/� By ----I�C�r��ty__.. ----•---•--------------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- --------------- --------- DATE ..... `. _y_"_47 ----------- BUILDING PERMIT-ISSUED------------------------------------- == ------------- _===--------------------------------.--.--.DATE = ....... ------------- ADDITIONAL COMMENTS ______ _�_._ „__,__ ___- --__--------------- 1'--; Final Inspe 'on by: - - -- ---------------------- ---- ----- ------------ ---- Date -----+�J T - SAN,JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M