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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 46 .7 -- r " (Complete in Triplicate) ,�Jhis Permit Expires 1 Year From Date Issued r� Date Issued -:I- --.--7... 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 i ompliance with County Ordinance No. 549 and existing Rules and Regulations. 'JOB ADDRESS/LOCATION .__.A v;L � ' =f-- -------------2----- CENSUS TRACTa JJ _ � r � e Owner's Name ------o rf. G'4' Ey------ ._e- G1� ----------------- Phone ------------------- -- ------------ Address --------------56ke/5�------- -- - City -06 P-�-0--Al------------------------------------------ .-........ Contractor's Name ---C4_ .CI--- -----�.�Y1--------------------------=--------License # �1I�;X"--- Phone Installation will-serve: ��74f-o-,Resil�lence J? Apartment House❑ Commercial :[--]Trailer Court E] r Motel ❑Other -------------------------------------------- Number of livingunits:-.- 30/9Gy�S �____- Number of bedrooms _________Garbage Grinder .___________ Lot Size _______________ ____ _____________.... Water Supply. Public System and name -----------------------------------_-------------------------------------------------------------------------Private Character of soil to a depth of 3ifeet: Sand'®' Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam 'n 4 Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot __________________________(Plot plan, showing size of:lot- location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No se tic'tank or seepage pit permitted if public sewer is available within 200 feet,} - PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth _ _.____-_-___________,_- sp Y TYPe -------------------- Material- ------------ ------ No. Compartments to n ares"" Well ----Foundation ----------- Prop. ------------------- Distanc -------------------------------- I I_ � LEACHING LINE No. � __.-_ ____-- Length of each line______ _______-------------- Total Length -----------...-•------------ 'D' t Boaz----------- Type Filter Material --------------------Depth Filter Material -------------------- --------------- Distance to nearest: Well.------------------------ Foundation -----:------------------ ..Property Line ------------------------ SEEPAGE PIT f � bepth ------------------- -Diameter -------_.__-__-- Number --------- ---- Rock Filled Yes F1No .❑ Water able Depth <7----------------------------------•-----------Rock Size -------------------------------- Dista c t&.nearest:,W61 ----------------------------------------Foundation -------------------- Prop. Line ----------- ...... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date _______-____-_________________---_} Septic Tank (Specify Requirenients) -------------------------- ------------------------ -------------------- -----------------------------------z----------------------------- rop Disposal Field (Specify Requirements) ____ oma' .aj" eG�---1'_/`ry�' %�i' �a/r--_-- -- X�sT�, ► S _f --- '--------------------- -. [ --- ---- -- -- - - - ------------- --- (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 j County Ordinances, State Laws,'and Rules and Regulations of the San Joaquin Local Health District. Home owner or Hcen- 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 �tro Workman's Compensation laws of California." Signed ------Fr --�hl_--i.ca/�r --- ---��---------------------------------------- Owner 4 BY -------- — - Title f .s ner) , R .DEPAATMENT USE ONLY i ff r APPLICATION ACCEPTED BY ---- ----------------------------------------------------- DATE �3� - BUILDINGPERMIT ISSUED ------------------------------ --------------------------------- ---- ---------------------------DATE -------- ------------------------------ ADDITIONAL COMMENTSIr �lf-ty7Q ---------------------------------------------------------------- -------------------------------------•----------- f ------------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------- ' ___________________________________________ _ ____ [ Final Inspection b -------------------------------------------- ------.Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.