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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT }Complete In Triplicate) Permit No. .Z7-... .............•�.- ......-=---.I---- �... Phis Permit Expires ! Year From Dane Issued Date Issued .l .............. Application is hereby madeM to the San Joaquin Local Health District for a permit to construct and install the work herein 'described. This application is mode in compliance withonly Ordinance No. 549 and existing Rules and Regulations: 1JOS . - _ ADDRESS/LOCATION ............. ......._._�d�..hiAS.Q_.� ----- .4...........:...CENSUS TRACT .......11.6......... Owner`s Name _.._..._.__25,&ak.._..___..29ne.1.Pr .. :. .....Phone ... . ^ Address ... ..... e�.-� - � -l-X75- -!' ...•-- ._ .. City .... 5. !'�.�G_!!�..:...............•---•---- ................. Contractor's Name ------ .�S-Q. -1�K_�1 .�----•----- ---------------------L€cense Phone Installation will serve: Residence 4 Apartment House] Commercial O'Trailer Court 0 ): Motel ❑Other...'........................ ................ Number of living units.-.73 ._ �.... r of bedrooms A......Garbage Grinder AO.... Lot Size ---_.-------•----.--•..----•................ Water Supply Public System and name::` Num . -. -•----•- --...---.._...................._........w........._........._.......................Private Character of soil to a depth of 3 feet.. Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam.❑. Clay Loam ❑ i� Hardpan C7 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,) PACKAGE TREATMENT ( ] SEPTIC TANK; ] .. Liquid Depth _ Capacity .................. Type .................... Material....................... No. Compartments ......................Qj ,F Distance.to nearest. Well ..Foundation ... Prop. Line 40 LEACHING LINE { ] NcJ of Lines ........................ Length of each line.....................•....... Total Length ........................... N D.I Box ............ Type Filter Material --------------------Depth Filter Material ............................................ Distance to nearest: Well ----_-------_- ...... Foundation Property Line SEEPAGE PIT ,[ } Depth ----------. Diameter ................ Number ............................ Rock Filled Yes ❑ No (3 V Water Table Depth -------_-t-------------------------------------Rock Size DistoiM -----• Prop. Line D nce`to nearest: Well ............... ..Foundation V1 REPAIR/ADDITION(Prev. Sanitation,Permit -- ---•.........:................:........ Date ....... •.-•---------.-:---.-) Septic Tank (Specify Requirements) ._VA. a ..... ....... .Q.!'j.�•. .�_l. _... -A--------.-.-.-.-.-.-.-.-.-------------- .......! .. .. P -----' `' Disposal Field {Specify Requiremen )� ��`......rL� � ......► �1 - -I x it A. ting sand req iced addition on reverse side) I hereby certify that I have prepared this k4plicatl n req that t work will 6e done in accordance with San lot:galn County Ordinances, State•Laws, and Rules,and Reg fations a toe San Joaquin Local Health:District. Home owner or licen- sed. agents g is signature certifr�,s the following: , "I certify that in the.performance of the work for^which ll permit Is Issued, l shall not employ any person in such manner as to become su ct -Workma 's ompensatiah laws of i farnia." Signed -----•. g I� . _.._` t - Owner E ` /1 }� �- ^ 4 BY ;� Il TitEe 1. _1.�t�-f -c. �' '1 I i (If other than owner) _ II FOEPA `MENY 1JSf%NLY APPLICATION ACCEPTED BY : ------------ DATE= ...�_ ..2� .7 _..... BUILDING PERMIT ISSUED _'!M.._.. .--.._ __..A. DATE .... _..._... ---•....--•- :. ------ _--------•--•-•---•---------.__ ......_.. ADDITIONAL COMMENTS --'M-----------•-- - ---------------- ..................... V.__._._._!,k V-1...................... -- ... �.................. ------ i!- 1M ... .. -- ------- ---------- ---- ------- Final Inspection by: - - �M _._.. ----------------Date Z .. EH 13 2h 1-68 Rev. AN JOAQUIN 'O�AL HEALTH bISTRICT $ It 3M EA � i • t� s