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FPR OFFICE USE: , c��4----------------- r 7a /Q APPLICATION FOR SANITATION PERMIT 70 _ 5/ w� - ------ ------ ----------------------- Permit No. --------------------- This ------ ' ---------- {Complete in Triplicate) -- This Permit Expires 1 Year From bate 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--------W-:-----7 - -- ---------- -------- -------------------- ------ ------ ---..CENSUS TRACT ...... -1.------------- Owner's Name -__ _----�--------Uj-_R iMA-lj----------------- --------------------------------------- ---- ------------Phone ._616-3Y?a��------- -Q 5.O ----------------- ----------------------------------------------- City ---S-TKA------- --- ----- Address -------- ---------= "ISLoi-------------------- Contractor's Name -------- -- - ----- -- ''------------------------ - --------------License # - - "-- ------ Phone f 9� ��--------�•� Installation will serve: Residence CKApartment House❑ Commercial :❑Trailer Court ;❑ I Motel ❑Other -------------------------------------------- Number of living units:---- ------- Number of bedrooms ------ -----Garbage Grinder ....... Lot Size ____________________________________________ Water Supply: Public System and name ----------4L�--__WFC •.------------------------------------------------------------------Private ❑ ; Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam -❑ Clay Loam ❑ } Hardpan ❑ Adobe 9k 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,i 11 . PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-----------------------------------•--------------------------------------------------------- Liquid Depth -------------------------- N Capacity ---------- -- Type -------------------- Material---------------------- No. Compartments ------.._,-. ..... f"� TA&- iilsTiM6 Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------------- r LEACHING LINE No. of Lines ...... - _ Length of each line---------'��____.___._ Total Length --�/�`70.... ........... y D' Box 136 Type Filter MaterialDepth Filter Material --------- _(�a___________ _______._----- .. Distance to nearest: Well ------------------------ Foundation -----4 Property Line -----____---------- _____ SEEPAGE PIT [ ] Depth -------__�_______ Diameter ----"'-`-------- Number ----------- —--------- Rock Filled Yes E] No 0 Water Table Depth ------------------~----- --------------------)tock Size --------------------------------- Distance to nearest: Well `___________________Foundation -----— Prop. Line -----'STM.._.-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------_-----------1 SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------<---------------------------- Disposal Field (Specify Requirements) ZOszloc-is ___�-!N ------` ----'!� --.--- 1S tS+J . ------ S��n( YO_ _to 5 411LA--------------------------------------------------------------------- ' ------------------------------------ (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 ' 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: "1 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 becomesub'ect-to /Woorrkkman' sation laws of California." � Signed ._f ------ Owner By ------------`------------ -----------------(= [t�5 V1- - ---- Title --- ---- - (If other than owner) FOR DEPARTMENT USE ONLY /� ! APPLICATION ACCEPTED BY -- -- ---- — DATE BUILDINGPERMIT ISSUED ------ - -----------------------------------------------------------------------------------------------DATE --------- ---- ---------------------------- ADDITIONAL COMMENTS ---------------------------------------------------------------- 't tS---- _ SATS? I --+ ` lM 3D---- �M� ---- t c7�'JLfL Sc'.Lu",1S_ f 1 f�1 I ----��-------- �^` �= r __ao._"�lizni 14 F'nal Inspection by: tit 1� �9 X� � - Ecc.��j ,� ___�_H_ ateU ---------- � � SAN JOAQUIN LOCAL HE DISTRICT ' r E. H. 9 1-'68 Rev. 5M