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FOR OFFICE USE: APPLICATION 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 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 ---31 39,P---E ------- Q��`' ------- - ------CENSUS TRACT ----- -------•--..:_.. n Owner's Name --------- 0 �------A1-E-1>-f--/V19------------------------------------------------ -------Phone ------------------------------------ • Address --------- - �_779- nss_ ._-: ,.�., _�_ ®� City ----OA—KD�q_j_F---------------------------- -------------- - Contractor's Nam .._ f _.--__ } ? _---T&N S---.License # Sir _ ___ Phone Installation will serve:. -Residence (�6artment House[] Commercial ❑Trailer Court i❑ r;) r Motel ❑ Other -------------- -------------------------- Number of living units:------{ ---_ Number of bedrooms _ _____Garbage Grinder 1169--- Lot Size _- ---------------------------- Water ------ ----__-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 If YA, type ____________________________ (Piot 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 seeps a pit permitted if public sewerlis available within 200 feet,} ! t \ PACKAGE TREATMENT f ] SEPTIC TANK Size-___ I _X --=--Liquid-Depth Capacity 1ZOO_-.__ TYPeP?EU-5�iMaterial0�YUXRT-____ No. Compartments ----• - -------••-• Distance--ta, nearest. Well - :' 7+------- Foundation, Prop. line - ---- ------ „ _ - ------�length of each line �- ti:. ( CiIt�G LINE ` No. of Lines) - I O_ -} t_� g .._ i otall Le^90Q ij Distan a t earest:Weiler l� ialFoundati Depth Filter Material :-___-- -' _ -;-----•__-- Type-filter & Qn -----� --- ------ property, tw+e / ------- ' i t I { SEEPAGE PIT [ Oepth ___f�f /- ...7t---, Q1arrwvter X 2_--_-- Number ----:---- -- - Rock fiilr/ Y�c �1�10 [] Water Table 13epth! ------- ------ -------=----- - F ; T Distance to nearestoWell -__ 60----- ---------------------Foundation *tea• time ------- ** AW/A0D"4 (Prev. Sanitation Permit# -------------------------------------------- ldate ----------------------------------�., v� € Septic Tank (Specify Requirements) - --------------------------------------------------------------- ----------:----A-------- ------------------ ------- Disposal,.Field ---•-- DisposaL,Field (specify Requirements) -'# ---- ------------------------------------- ----- +t ------------------------------------------------------------- - ------------------------------------------------------------- ---------------------------------------•-------- i } jy W i- ----__________________________ _ _ ___� ---------------------------------------------------------------------------------------------------------------._._-___-,!__--_. (Draw existing and required addition on reverse side) ' I hereby certify that I have prepared this application and that the work will be dews in accerdance with San Joaquin County Ordinances, State Laws, and Rules trod Regulations of the San Joaquin Local health District. Homt owner or iicen- I sed agents signature certifies the following; sI "I certify that in th ei*formap'c of the work for which this permit is issued, I shall not employ any person in such manner as to bec a sub' to W' 72, k''an's p a�io laws of California." Signe - ;: ----------`--------------------- Owner BY -----1-- '------)7�_R�,M-dg^I"------------------- Title ----------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By 4 'fs�----------------------------•--------------------------- DATE ------ - BUILDING.--PERM-IT—ISSUED "�`"`_ _ _._.._._.. _ ( -- --- DATE. .��__-__.__ _— ..._.. ADDITIONAL COMMENTS - ---- r 1) P-7`y _Cg �� --------- �7----- d' I[ ------------------------------- - -- -----`------------- - ---- `----- --- -- ------------ -- --- --- -- T Final Inspect' by: --- `` Date --------f.. ..... .r------ ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. '