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F(5R OFFICE USE: + APPLICATION FOR SANITATION PERMIT ------------------- ------------------- r, ---------- (Complete in Triplicate) Permit No. --.Z --- ----------- --------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and -install the work heren described..This application is made in compliance with County Ordinance No. 549 and existing Rules-and Regulations: E I E �Ji F JOB ADDRE=5b7iU�H -�fYTION . ---- CENSUS TRACT Owner's Name -UJ_1=66P----- - --- n � ��3-t�.i`lT - -------�PtC-��'------GLtil�.�i--------------------------------Phone -�7�7�-7 I l_1-.�C�-, Address . .v _+ <= C�-V_ Cit 5 ' - ------------------------------------------- it— Contractor's Name - ---4�.- _hl_- $------------- ------- - ------.License # '' •- Phone -------7-`' Installation will serve: ',` Residence E] Apartment House❑ Commercial:❑Trailer Court ❑ Motel ❑ Other�C Q - _- 2/kL Number of living units--' Q Number of bedrooms *r�Garba a Grinder 1 $. g - Lot Size t�2�•Gik��-11�_ Water Supply: Public System and name .� -- t ----------- ---------Private/ Character of soil tc depth of 3 feet: Sand-© Sil�—,Clay. ❑ Peat E] Sandy Loam ❑ Clay Loam [] Hardpan ❑ Ado6-e '(] Fill Material ------------ Ifes t I Ytype ------ ------------------ . (PlotIan, showin � � p g"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 - 1 SEPTIC TANK size---0Q©I_AbDylla----- L,q uid Depth ------ ---------`----�- Gcapacity -'-'-------------1 Type -. . Material - No. Compartments -- '----- A,..---- Distance to nearest: Well--=----------------------- ---------Foundation -------- ---- l ------ Prop. Line --------- f 1 LEACHiNG LINE No. of Lines ----�-----_____________ Length of each line 10-`�._ x�ral Length -- -------------------------- �'D' Box �f Type Filter Material Filter Material .� ................. Distance toj nearest: Well --- .— ---------- Foundation -..___- Property Line -- ------ SEEPAGE PIF [ ] De th - Diameter Number ------------ "--z'Rock filled, Yes ❑ No i❑ Water Table Depth ---------------------------------------------------Rock Size -------------- = Distance toBarest: Well ------------------Foundation --------'----'---Prop. Line ------------- (Prev. Sanitation Perniit# —--------------------------------------- Date 1 I ---- Septic Tank (Specify Requirements)Requirements) --------- -- ------------- ----------- ---------- --- -- ---------------------------- Disposal Field (Specify` ` -- ----�---- - --- ------- n—------------------------------------------ �— t: --- I herebycerci that,i have prepared this application n and required eata h e addition on reverse side) e 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compen3ation laws of California." _f % Signed --- Owner --------------- a: ------------------ 0--- J By - Title P&PT-------oaelo `I�_1�1 = (if other than owner) ----------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY i - --= - ------ DATE .> -�I_ .�' -Z----------------- BUILDING PERMIT ISSUED -.-_.,,.._--. - - _ '� L ADDDI ONAL COMMENT t /�- - -•-- -----------DATE _ --... ..... ... ------------------------------ ._..__ __..?_-- --- - - _ - - - - __. ..___....._- e ....................._.-...---.--- ---------------..._..__..._-_..-._..-.___-..-_.._....-------- - ..--------------------------------------------- .................................. ...... . .. ti. ! _ -..__..------------------------- ---------------------- -- _ ..._.-.-----. __ _...._.. -- FinalInspection b �_ ..._-.. , - -------- - --�------------------------------Date -�. ./--------- -._- SAN JOAQUIN LOCAL HEALTH. DISTRICT E. H. 9 1-'68 Rev. 5M