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' FOR OFFICE USE: _ ..�. APPLICATION FOR SANITATION PERII�� _ a ............................ . Permit No. 7S .. 1Coitiplete in Triplicate) k•-•---......: ...................... ...•• I.- I Date Issued This Permit Expires l Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t¢' construct and install the work herein described. This application is made in compliance with Co eify Ordinance No. 544 and 'existing Rules and Regulations: JOB ADDRESS/LOCATION ."....../. ....... .........................CENSUS TRACT .... ........... Owner's Name ........ 1 ... ..".......: ./w_�. .......... ........... ........................ f Phone Address .........:..:.� -.j..� ..........:-...S...-- .---�/4-Ra/.. "---........ City ...... ... fo_L:.ff- -N..... .......I...... .. Contractors' Name - y �1 . p AD P�• Installation will serve: Residence XApartmeht House�F1' Commercidl [ITttiiler Court 0 Motel C7 Other --- --------------......----=-----------=-- ►►��yy / +��, Number of living units:..../...., Number of bedrooms ... _--Garbage Grinder ....'�_ Lot Size .....1..7-../1..-I•I t�.••••-• Water Supply: Public System and name .....pL/.i®.- .�.. ... ... . .. re Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt E] Clay ❑ Peat❑ Sandy Loath (] Clay Loam ❑ Hdrdpan[J 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 t IX! j51 ........•.......... liquid Depth ........................... I Capacity .: .. Type -............ .... Founds No. Compartments ...................... ••----- Material.----...,-.- .... Prop. Line ...............•----- � Distance to nearest: Well .... ... ._ tion ........:- / // / 04 LEACHING LINE. No. of Lines _..�. Length of each line........ Total Length .-..�"'__o............... _ """""�`"'D' B "�va'.. T e F�Iter N4ater+al�•t-'�-Cd tion!h- F/ittMaterial �'"'--� �`� v---------- ox . W oe Distance to nearest. Well .lo. ..- E' I-Fou a / Property Line .4��•-• ` ` .epi..---...... .._... SEEPAGE PIT ( r be"pth. p� -- , Djorni tvr :,3.:__..„�Number ...-.-.. .. F.-::_; -- stock Filled Yes � No ❑ vl + � A �' R k Size '+ .r ...... .. x ' Water Tabie;:Depth=..- :. =�... ...._....-........ Distance to nearest: Well . .".A/e . _....Foundation -------- Prop. Line .."..l�.-..._'..._.. REPAIR/ADDITION(Prev. Sanitation Permit# �q_, .-1"..G�-� = - — Date _ ----)-.c•--�---- � �s Septic Tank (Specify Requirements) ... ..... ..y.-... �... �... _-.- ` ,y - Disposal Field (Specify Requirements) T , F................ . .......................... .. -----•. . -------- ......_---- ...... i (Draw existing and required addition on reverse sidel Y Y ` 1 hereby certify that I have prepared this application and that the work will be dere in accordance with San Joaquin County Ordinances, State laws, and Rules and Reguiiations of the San Joaquin tocol Health District. Home owner or licen- sed agents signature certifies the following: k V I "I certify that in the performance of the,work for-which this permit is issued,,I shall net employ any person in such manner as kg1become subject to Workman's Compensation saws of California." ( r Signed j� B Y : .. ... I /C.t�±CJ� . '.. TitleOwner ---..... C (If other than owner) f FOR JDERACTMET' USEONLY ACCEPTED B ...... DATE ............. APPLICATION ... BUILDING PERMIT ISSUED .............. ----- -------- -----. ..DATE . ......................... ........... ADDITIONAL COMMENTS ---- ........... ... :.........:......... .....----------------I_.---------- ...................... .'. #. �. ; _r!_ "a.f ----------------_:-------------------------- _....... _..... . . . --------- .......-.... ...----...... ---- _... . .- :.. . � . 1 Final Inspection by. - / . �(/. .. Y ^� SAN JOAQUIN LOCAL-�I'EALTH DISTRICT b c u 13 2 1--AA ad., 7 72 3. btu • _ — M-