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FOR 0IFFICE VSE- APPLICATION FOR SANITATION PERMIT' -------------------------------------------- - - (Complete in Triplicate) Permit No. ------------ ------ - -- ------------ ------------- This Permit Expires 1 Year From Date Issued Date Issued5_" fi Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application'sis made in compliance with County Ordinance No. 549 and existing Rules and Regulations: n - I JOB ADDRESS/LOCATTION .l._Lid!' ---?--.----ST if.ALE6U ------------;----- CENSUS TRACT .�-`- ------- Owner's Name ---- --------------------------- ----------------- -------Phone ------------------------------------ F Q Address ---- S iNr•G_(/'1"'---------------- CitY --Q/4D�-L ' Contractor's Name tA��A \_PT&� ----col--------------License # --------;-------------- Phone Installation will serve: Residence®'Apartment House-[] Commercial:❑Trailer Court Motel ❑ Other--------------C'----------------------------- Number of living units:.--.- -_-- Number of bedrooms � -_-_Garbage Grinder _ Lot Size __t9_CREA_ F-------------- Water Supply: Public System and name --------------------------------------- ---Private e Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay`❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpaner *7Adobe ❑ Fill Material 11YV_ If yes, type ----- ---_-------- (Plot plan, showing size of lot, location of system in relation to wells,"buildings,p 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'[ ] Size---__ ------------------ -.___.__._�t�_-- Liquid Depth --.---_______________ Capacity ------ ------------- Type ------------------I aterial--------------- No. Compartments ---------------------- --- --------------------- V Distance to nearest: Well -------------------' Foundation'-._____-_-----_-_--- Prop. Line --___--_-- _-:-____ Y - --- D' Box ._______.___ Type Filter Material -__W � line _.._____-. �_ Total Length _______________________•.__Ix LEACHING LINE [ ] Na. of Lines gth of ach I--- ., Depth Filter MaterialDistance to nearest: Well -------------------- Foundation -.-----_-._----_-------- Property Line _-..---.------_-_-.....SEEPAGE PIT [ ] Depth _________._____.__ Diameter ______________ i=Number .____.__ __.____.__._...____ Rock Filled Yes ❑ NoWater Table Depth -_--.----_. --- - -,f_"_�-f_Rock Size -- -------------Distance to nearest: Well --------------------- ---- ---•.Foundation ---------------.--_- Nop.'Line .--------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- -------------------------------- r Date ----_�----------------------..---) Septic Tank (Specify Requirements) �� - TC1 __.L�_ .- 11 __ Disposal Field (Specify Requirements) -FOR.,___FUT Fi�,__95XPRNU9tV------------- .------- - EAC _ �. ; ------ -li-- - � p ---------I-- ----2-�--------- ---- QX- W--------------1_N. `� fir- --------------- 2_�----- SaEPR_ Pers r (Draw exrsting and.required addition on reverse side) =' I hereby certify that 1 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. 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, I shall not employ any-person in such manner as to b e subject to, or 's mF aws of California.' f Signed -- Owner _,: �1 IV -- -BY - - ------------------------ '�`�R Title - A )) (If other than owner) i1 <`J FOR DEPARTMENT USE,ONLY APPLICATION ACCEPTED BY A_ � _-_=may - -------- 4------------------ DATE 1 ~ .• BUILDING PERMIT ISSUED --------------- -------------------------- - DATE - -- - - - - ------------ ADDITIONAL COMMENTS . -------._--------------------------- ----------------------- - ---------------------------------------IV) -ir►- -� t_4 ----------- ---------- __________________ ____+__________ _____ -_--_-_ _- -- ------- -----_ ___.____ _____ _______.______________.________________..__.___._____.__JF 4- ___.____________._______....___ ._ f • '�!v - - Final Inspection by: l'- --- -- --- - -------Date --- ---------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT ti- '� 9 E. H. 9 1-'68 Rev. 5M