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FOR,OFFICE USE: f r APPLICATION ICOR SANITATION PERMIT . (Complete in Tdplicate) -, Permit No. ... .......3__. .......................................... This Permit Expires 1 Year From Onto issued Date Issued ........ :71 Application is hereby made to the San Joaquin Local Health District for a permit to con:tract 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 ........ $.�_ a' QIP-1l H=IV - -.........._ i -----................ .............CENSUS TRACT ....... - Owner's Name .................. ------y .._. Phone 77:_ _•-------------•- -• ----- Address ............................... '7�/.. R lYT ................................... City -ST----------- ----....._..- Contractor's Name ..................*!.1_!_A.�_ �RL�'fal..�` ��1 5.---7T'M�--..License # ._ Phone ; Installation will serve: Residence Apartment House❑ Commercial❑Troller Court J] Motel ❑Other...................................:........ Number of living units:....i__-... Number of bedroomsff.........Garbage Grinder Lot Size _.}B 3C�gS_0 Water Supply: Public System and name .............. .....Private , Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loamik Clay Loam ❑ Hardpan ' P C:] 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 j ] SEPTIC TANK f l Size—............... ...... -- Liquid Depth Capacity --------•--------- • Type • = ........ Material-------------- No. Compartments ...................... L Distance. to nearest: Well ...Foundation ----- Prop. Line ........... LEACHING LINE j ] No. of lines ------............... Length of each line............................ Total Length -----........_ 'D' Box ......___— Type Filter Material ...................:Depth Filter Material ........... ........... Distance to nearest: Well Property Line ....................... Founda#ion �.......:......•--...... SEEPAGE PIT j ] Depth -------------------- Diameter ................ Number ........__...__..._..---.--- Rock Filled Yes ❑ No ❑ Water Table Depth ................................................Rock Size ............ ................... Distance to nearest: Well ......._Foundation ..._.. Prop. Line ....................... REPAIR/ADDITION IPrev. Sanitation Permit---� ---• -- Date ...........-------------------•-••) ---- Septic Tank (Specify Requirements) ............... ............ •-_-- --•-• .................. Disposal Field (Specify Requirements) --Z_--___ D'�,vA....... ----- �� "' � ".Lxv,.......... •------------------ �?^ � errz�.r,'1 AV ,a i5!.�6 O .......IDraw existing nd required addition on reverse s€de) 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. Nome owner or Ilcen- sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is issued, II shall not employ any person in such manner as to become subi<ect to Workman's Compensation laws of California." r 1 Signed _... + -,. ---t4�li�_LS_f!_.. X1 5...._..` 1l S..................... Owner By ---- ------------------------------------------ -••-- -_.. Title _. .....-._._ ......................... (If other than owner) , R DEPARTMENT��DATE APPLICATION ACCEPTED BY ��. ------------ .- ........--- BUILDING PERMIT ISSUED -----------. .__--_ •- ,-... ...--- ATE .......................... . -- ADDITIONAL COMMENTS .......................... -------------------------•---•---------- ------------------....... ................................••-974 -------• ------------------------ -----•--------...---------•--•• --------------------•- ..------------------•--•- -•----------•----------•-- •----.. J� ----------- Final f Inspection by: -_. _._ . .._._Date ... _.. .EH 13 2?� 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M