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FOR OFFICE,USE: - -------- - APPLICATION FOR SANITATION PERMIT ----------- ---=-------- --------------------- - --------------------------------------------------------- -- (Complete in Triplicate) Permit No. I �. ---------- --------- ------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a described. This application is made in compliance with County Ordinance No 549 and ex strmit to ipg' Rules and tand Regulationl the work s: < WS _g g JOB ADDRESS/LOCATION 203_�I f7 S p " - / �4------- ---CENSUS TRACT -. - ------------------------ Owner's Name -- L/ RE.�C: ------- :> _ Phane - - ---- a Address ----1 -- �� - . 3 1�'IE t P5P-- '- ¢� ----------- City --- Contractor's ---------------------------------------- i Installation will serve: Residence A artrnent'Ho Ff Name - Wrj. 'R �� !. � L"J p use°❑ CommercralSe �aiier Court ----- Phone ------------------------- ❑ ourt ',❑ t Motel El Other `-`----------------------------------- Number ------------- -------------------Number of living units:.__-- ____-_ Number of bedrooms-11 e Grinder _ '�- r 9 Lot Size ------------ ------ --------------- Water Supply: Public System and name ---------------- --------------------- =---- - 1 - Private � ` = Character of soil to a depth of 3 feet: Sand' Sit k ❑ l ❑ Cla F a _ y `❑ ._Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe❑ Fill'Material --N� 'if yes, type'-'---_"------ a, �F (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 -------------- -- - ------- Liquid Depthtank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC PACKAGE TREATMENT ; T NK.'[ J Size-- X �) _S`- [ ] D _ ----- -- - ------- ------ -�/----�'-........ Ca TA pacitySQ_L7_,-_- Ty'pefR Ff :J3� Material--CoN ,=___ No, Compartments {„f s-- Distance to nearest: Well ----- --- - - --- �--- Foundation -------___-.- -- p• - L -_ Total Len th _-- �0_-_.-______ _ _ ��.- - Pro Line _-_ LEACHING LINE [ ) No. of Lines -_.--- _-Z Length of each line------- Q t _ 'D' Box S Type Filter Material -RQ ___Depth Filter Material j �g t ` / Distance to nearest:,Well ------ Foundation _/0-__17 Pio perty"Line'-�5 -�__-- SEEPAGE PIT Depth -------------------- Diameter --------- ------ Number - -------------------------- Rock Filled Yes ❑ No �. Wate`jable Depth --------------- - - --------- -------------=--------Rock Size - -------------------- ' } Distance to nearest: Weli ------------ -------+-------------------Foundation --------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation(Permit# -------- ----------------------------------- bate ------------------•- Septic Tank (Specify Requirements).-; '--- -- ------ ----- ---------------------------------------------------------- Disposal Field (Specify Requirements).,'__}-_"___::-_ ' ------- -' ------------------------------- ----- ------------ -- ------ -----_ }- ----------------- ----- t j{Draw existing and required addition on reverse side} 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and;Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed•agents signature certifies the following: ' } "! certify that in the performance of the work for which this permit is issued, I shall not employ any person. in such manner f as to becomes Zoorkman s Copppen n I f California.,. Signed --------- -------- - = _ - --�,---- ---}--- --- Owner BY ------------- - `� ---�`------ -! � Title ---------- -------- - -- - - --- - - ------------- ------------- -- (If other than owner)-" ' -- ---------- --------- ---------- ' ' ' FOR EPAitTMENT USE ONLY APPLICATION ACCEPTED BY ------ , ------- -------------- DATE - =J..� - 615 BUILDING PERMIT ISSUED • - --- :� " t'�=- --- ADDITIONAL COMMENTS ---------- - -- - = -----------DATE .: -------------=----------- ------------- --------------- ---------- -------- - ----- ---------------- ---------------------- ------------------Y I ----------------------- ------- -------------- --- ---- - -- ----y------ -- ------ ---- --- ---- ------------=------ ------------ - - --------------- -------------------- - Final Ins 'on b - - p Y -- ----- -- - ---------Date . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M