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FOR--0F CE-USE: APPLICATION FOR. SANITATION PERMIT "------ -------- - ------------------------------- - -- -- ' , :- Permit No. Z- 7 G7 � ��----- �-•---.�.�..•(Comp€ete•in_Triplicate)---------•--- . �- ---------- ----- -'---------------------------- -.------ ` Date Issued _____•______-_i!______ This permit Expires 1 Year From Date Issued Application is hereby mal a to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application istmade in compliance with County Ordinance No. 549 and existing Rules and Regulations. 106 A �� -:-- - �-�2.. ` / DDRESS/LOCATION_ . R_ + t �} -4 �---6T`-------- -" IPS-Fes------CENSUS TRACT - �---.---- Owner's=N_;ame {V 4.4--.� L.7 ----- ------- ----------------- ------- Phone --- _ ress _ lTzr _ iCity-rQ�+ - _ Contractor's Name --- .�� i�'� � L -----_MNK _ -------- --------License # _rLS;777- Phone --------- ------------------ installation will serve: 1�e�sienSApa�rment_House.0 Commercial :❑Trailer Court ',❑ f 1 Motel ❑Other ---------I-------- Number of living units:_.__ _._.___ Number of bedroZX ___Garbage Grinder ___._-__ Lot Sizer fi g `- t, J--------- ----------------------- i Water Supply: Public System and name __ _� Gj --_-- - S- =-`--;�-------Private ❑ -� I 1 r . - - _. Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑� Clay Loam :❑ C r Hardpan ❑ Adobe ❑ Fill Material {�__ If yes, type ___-_-__- (Plot plan, showing size of Iot, location of system in relation to wells, buildings;, efc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank or seepagg pit permitted'if public sewer is available within-260-feet,) �t PACKAGE TREATMENT [�] SEPTICTANK� t Size--------------------- _._6______________ Liquid Depth ___ ______________.. Capacity / ' pe!hF )C - Compartments .- - C Vil------------------- _ .r T:--��ndation ------ - �- „- �. Distance to nearest: Well _______ ___ _ � -- _ _____ prop. Line ._ .�________�_.__ LEACHING LINE [ ] leo. of Lines ------------------ ----- Length of ez(ch ime____.�3`_.�___�-------.__ Total'�L-ength __1/_C2___.._._.__ rrc.TER 13ED .ID, Box es_ Type Filter Material fJGK.-Depth Filter Material ------- ------ ----------------- 9p0 a Distance to nearest:. Well ---- ------ Foundation.,Il------------- Property Line ____�_............. SEEPAGE PIT [ ] Depth Diameter ________________ Number ____- -------_______._____ Rock Filled Yes C] No ❑ WaterTable Depth ------------------------------------------------Rock-S.ize -------------------------------- Distance ------------------------ -----Distance to nearest: Well ----------------------------------------Foundation ------ Prop. Line --------.-----------_. REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ---_ t ,---------------1 -- bate ----------------- -k _ _ --- Septic-Tank (Specify,Requirements) ------------ -----_-- ---------------- ----------------------�------------------ -- ----------�----..-------t--------- ---•- 9 Disposal Field (Specify Requirements) ------ 3- `- -�%V 1 _f- -f— ----------1 tom. .......... -----�----- r - ,-- CJ CK--------- a l R C !tiJ t`1-l`� �_ ` �� -� `� ------- --- r-- ----------------------------------------------- - - - ' n and that theno'r i (Draw existing and required addition on reverse side} ' € hereby certify thAr at I�h Nve prepared this applicat o a rk wilf be done in accordance with San Joaquin County Ordinances, State..Laws, and Rules and Regulations of the San Joaquin Local Health/bistrict. Home owner or licen- sed agents signature certifies the follov;ng: "I certify that in the performance of the work for which this permit is issued, I;%hall not employ any person in such manner as to beco a subject to Workman's Compensation laws of California' " I Signed'- l r S `"�� Owner By ----- = --- ----- ----I `ff ------- ------------ -Title ------ --------------------------------- (If other than owner) . ��. FOR DEPARTMENT USE_ONLYk� ---�� -AT r APPLICATION ACCEPTED, BY ___.- T'f ' 1!2-------------------------"-------------- -------'---------- DATE __.. - �- ---------- BUILbING PERMIT ISSUES ---- -------- ''------------------------- -------- DATE ------------ --------------------------- ADDITIONAL COMMENTS ----------=-----� --- ----- - --------------------------------------------------------------- - OE. �; I' ---- -- -- ------- ---------- --------------"---------------------- --------------------------- ---------- ----------------- -------- ------ - - Final.lnspecti. Date ------- -----�- --�--------- I ___- ----___- ___= _ _ _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1 E. H. 9 1-'68 Rev. 5M :F