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r -K FOR OFFICE USE: .. APPLICATION FOR SANITATION PERMIT o/ ----------------- ----------------------- Permit N(?. �l= (Complete in Triplicate) ---------=----------------------------------------------- 0a L.A. .- _ { _-_. , t. This Perm if-Expires,I Yer from Date Issued Date ]slued 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: JOB ADDRESS/LOCATION ..- 5� 2 IV .!\------- ---------------- —-----CENSUS.TRACT Owner's Name BF—T—7 -' 1 _01-NDQ-RI_1---------------------:' . `�----- _Pho e Address " = ---------D----------- City SCQ ------------ ----------------------- Contractor's Name ----f�-W _ = = - ------.License # -------_--------------- Phone installation will serve: Residenee ❑Apartment House❑ Commercial ❑TrailerCreftrt-E} �,I r 71 -- -3 11 :v } ;.._. �. Motel [] Other ` ` Number-of-li win - g units:--- .__ Nmb -- uer of bedrooms �---Garbage Grinder ------------ Lot Size _- �1 7_ --_______.- Water Supply. Public System and name --------------!-__r ----------------- Private �~ -----•--------- Character of soil to a depth of 3 feet. Sand'❑ Silt E] Clay ❑ Peat Sandy Loairhj� Clay Loam ❑ Hardpan E] '-A'dobe-E] Fill Material - -. k If yes,type --------�___________________ ` w. (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-seepa pit p rmitted.if 'blit sewer is available within 200 feet,j W PACKAGE TREATMENT { ) SEPTIC TAMC'[ Size-- _- __��_ ______ --_ Liquid Depth -_ -7�-------------- Capacity .100---- Type 0ArC4ETDyateria1W_& 57_No. Compartments ----_tz— l ,, r istance to nearest: Well S" "�':-_--__:--Foundation , �� '"�--�Prop. Line ------5•='�-�--- LEACHING LINE [ No. of Lines ----:— --------- Lengfh'!of each line-`:-_7�_----.---___ Total-"Length �� Ir D' Boxes__ Type Filter Material l2-_�0�undation _1�"Dkpth Filter Material _--�9- __-------------�----.________._ Distance to nearest: Well -- _-_ --.-.11-9__----------- Property Line ' - ....... f SEEPAGE PIT [ ] Depth -------------- Diamet ---_--_---_----- Number --------- ------------------ Rock Filled Yes ❑ No i❑ Water-Table Depth ------------------ ----------------------------Rock Size --------------------------- Distance to nearest: Well -------------- -- ---------------------Foundation ----------------- Prop. Line ------------------_.-- REPAIR./ADDITION iPrev. Sanitation Permit# ------------------------ ---------------- Date ------------------------- ----) - e i y Requirements) -----------------/-- � r Disposal Field (Specify Requirements) ---------4,r _t�[- - Jf---------- 4EA-M_ -�----t-------------------------------------- ------- --------11 � -1�--------- - �.Q_�-r' 7 'A� rr�:t�-t--- v1� 9i ,KEN Q�11= <�} (Draw existing and required addition on reverse side) I I have prepared this application and that the work will be -done in accordance with San Joaquin County Ordinances, State Laws,<<an the San Jeoquin Losel .Health District. Home owner or licen- sed agents signature certifies the following- -3--17-7-3 —(773 . "I certify th in the kiorkman's mance of the work for which this permit is issued, I shall not employ a in such manner as to be a subject Compensation laws of California." SigneOVwner BY -------------- --'----- ---- Title ------ ------ ----- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------71__�_ �Q--------------------------_ - - _------------ ------ ------------------- ----- DATE -- p`7 i=7/-------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------=--------------------------------DATE ------------------- ----------------------- ADDITIONAL COMMENTS --_ -- --- ------ - - -_ ,- - ------ -- -------------- - _ = --------------------------------------- --- --_-_ Final Inspection -------- -------- Y by: - ------- ' -------------------------- - SAN JOAQUIN t'OCAL HEALTH DISTRICT _ E, H. 9 1-'68 Rev. 5M R ��