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Y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 72-321--- P p Permit Na. .-- ---------. (Com Iaete in rri licate) _ ------------- --- ---- ----------------------------------- Date Issued 77 ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr'ibed.•This-application is made in compliance_with.County Ordinance No.,5.49_a6d_existing Rules-and-Regulations: /or .3 0 p JOB ADDRESS/LOCATION ---M3 7 ---, ------- .t' ,- �E\------CENSUS TRACT --- '+� ---- Owner's Name --- -- -� - -I� - --- -------- - Phone =� Cit Address ------'-------------- ---- ------- ----------------------------------------------------------------'" Y ---------9-8_P 44----------------------------------- --------- Contractor'.s Name _/'-1 - _ C _ y 1Y License # ----------------------- Phone ------------------ ----------- t y�! Installation will serve.. _ —Residence-e-9(partment House--E] Commercial :❑Trailer Court I❑ Motel ❑ Other . =------------------------------------ 11% Number of- living units:._----/-. r-Number-of bedrooms; :_=__Garbage Grinder��. __ Lot Size _ _ ---------------------------- m ��` '-________----- Water Supply: Public-system and name -.-45?�JN6----CIAF +- --------C W- -----------------------------------------Private ❑ Character of soil.to a depth of 3 feet: _Sand Silt❑ :.Clay:[].....-.P_eatu❑.,...�Sandy Loam ❑:—_Clay Loam ❑_ _ w� -� [ '�'\ Hardpan ❑ Adobe ❑ Fill Material -IV1-�__ If yes, type -------------------------"- /rIS\I (Pl'ot'plan, showing(size of lot, location.of system in relation to wells, buildings; etc. must -fie placed on reverse side.) V NEW INSTALLATION: (No septic tank or seepa it'permitted if public sewer is 'd�ar il'alble�w'ithin 200 feet,[ // p, PACKAGE TREATMENT j SEPTIC TANK.'[ . ,, Size-_. _Xl Q_A-6------------------ Liquid Depth --- --------------- Capacity Type5-04�Material aC0 No. Compartments — ........J istance to' nearest: Well _ °'__ -------------Foundation -/_f --------------- Prop. Line __ ______' LEACHING LINE [ No. of Lines _3----------------- Length of each line.=l_.-_ ---- ---- Total Length ___-,f-7___-.-:-----_--_ D' Box/4�,S._ Type Filter Material N1, pN- --_Depth Filter Material ---_____________________-`____.____. Distance_to=nearest: Well -____ ` ----- L4/ ------------ F, ,_-,_-_f--_.-_-- ----_Property_Line__-______.._::_.__._.___ ri trti 1�'.��F�" � 9—!a �� s�� .�- '� ---------- Rack Filled Yes o � [ ] Depth D!ametet .- ----- Number ----- ----- [--N ------------ - Water Table Depth --------Rock'�Size -------------------------------- Distance ---------------------------Distance to nearest: Well ---_-------------------------------------Foundation --------------------- Prop. Line ----------------------- REPAIR/ADDITION{Prev. Sanitation Permit# _--_-_--._ --------------------------------- Date --------------- -------�_----:-�:1 \ � SepticTank (Specify Requirements) --------------------------------------------------------------•------------------------------------------------------------------`-----•---- Disposal Field (Specify Requirements) ___-- t �f1l� `.�-/�-�-l\(----- R H 1--At ------- -- ----------- `----------- 1�-_._L-i _ _ _.. -- ------------------ -------------- -_ -- --------- ---- = _ (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. dome owner or licen- sed agents signature certifies the following: "I certify a in the performance of t e work for which this permit is issued, I shall not employ any person in such manner as to!bec a subiect 40*orkman;s 3fornpensation laws of California." 7 ` Signed ----------------------------------- Owner T By -�, . : v -- _.- ^; � 4 _ Titled t ` -------------------------------------- ' --- (If otlier'than owner) APPLICATIONACCEPTED By -----------R,-0----------------------------------------------------------------------------- DATE------`fir= " . ------•--- BUILDINGPERMIT ISSUED --- ------------- -------------------------`---------- ---------------------------DATE ----------------f------------------------- ADDITIONAL COMMENTS ---_ f*�-------- - - - - - - _ -- ._ --------------------------- --------- -------------------------------------- - ----- --- , ------ ----------- ------ - ----- --= - •- 1 i ------- _ _ - c a -- - -- ---< - l'---------------- r� Final Inspec = -----------------------------Date --- -------- ---- --- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M