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FOR OFFICE USE: 3 r APPLICATION FOR SANITATION ... ..._.. . PERMIT ........ s........,_........ {Complete in Triplicate} Permit No, 7 .5--•- . _......_. `..... ...... . .. This Permit ../.._�a. ..J...� Expires 1 Year From bate Issued Date Issued Application is hereby made to the San Joaquin local Health District for permit to construct and install the work herein described. This application is made in compliance with County rdinan e�No, 549 and existing Rules and Regulations: JOB AQQRESS%LOCA ON L� L(.� �� " ._....- ......CENSUS TRACT Owner's. Norpe_ L�J..� , ......CSL-_...._..�6__._� Address .._ �9rn; ..._ .Pho �1...---- Phone. .. � � Contractor's Name . _ a; A , t o.... _ ..... `3--- icensei ............ phone __... Installation will serve: Residence []Apartment_Housed7cC mmercial Trailer _ - . ..� ❑ Court ❑ I MotelOth jr _........ .........#.----------------------- Number of living units:.._• -..... Nei nber of bedrooms` ---Garbage Grinder .-___-._... tot Size .............. t ti "" � ------•------_---- ........ Water Supply: Public System a`ndtname ._ - - /----••• I w ---------------•------------------------- -.-.-.Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Peat ' � _ �[)- Sandy loam (] Clay loam ❑ � I N Hardpan ❑ Adobe Fill Material _..._ - If es, __ � � ,..,..r._ - - Y type --- ------------------• {Plot pian, showing size of lot,-location of. system in relation to lis, buildings, .etc,.must be placed on reverse side.} i r NEW INSTALLATION. F - ' {No septic or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TAMC_ Size. � . ' I _,..._41 a ._ ........ ............. ........ Liquid Depth ......................... Capacity -- Type -----------------=-- .... Material ... :. _. ( I No. Compartments -----I................. Distance to nearest: Well . . ._ •--•-•---------_-_-.-Foundation ..--- Prop. Line '._. LEACHING L NE [ ] No. of L,net Length of each line ......• - ..-... -..._ Total Length D' Box Type Filter Material *� -------_-----------Depth Fi ter Material Distdnce to nearest: Well .......... ............ Foundation ................ ...... Property Line " SEEPAGE PIT [ l Depth Diameter........--.----...__.,Number Rock Filled Yes ❑ No . .. ....... ❑ .W.,Water.�Table Depth._._... ---- ••----_---•-•------Rock Size ------------- Distance --------- ------------- I REPAIR/Ai]pITION(Prev. Santa#ian Permit t#Well...:-- Foundation Prop. Line ------------------•- _ ' ,' ._ 5eptican {Specify;Requirements) _.,...: ... Date __. -----41 Disposal- Field Specify Requirements}a_...__ t _,777b �._. 3--b-. .. s`'..... .. -- . r. - - - -------------- ------------------------ ----------- - --- - ............ (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 1Regufati sed agents ons of the San Joaquin focal Health District. Home owner or licen- n "I certify thsigi the prior anee ofure certifies the following: ons he work for which this permit is issued, I shall not employ any person in such manner as to beco bjemaosm,,p�ensation laws of California." Signed .... !�Gr.�/G . .... . . ......•- --------•---- ----------•-- - Owner f .By ...: . .......... Title ........................ - - {If other than owner} .. ..--.............. .-- ..._.----._....._. ..----... — -- _ DEPAR MENT USE ONLY APPLICATION ACCEPTED BY :._. :... � Q/✓Cl DATE ......L.�n --�. .. BUILDING PERMIT ISSUED ADDITIONAL COMMENTS . . . ..... - ......v - ..........DATE _ ..-:- ----- ......__:• --......------- ••-•-------- ------ -- ........ --.....------•---------- �' - -c� h -- : 0- 1�::------ --- x:7:y ---: - _ ::::::;mac------------ - --:::::: ---------- ------------ ---------- Final Inspection b ----------------------- ........-•---------- .-. p Y _ ............... ....._ ---. _ -•----Date . 0..-r .-_. -�f... ' SAN JOAQU LOCAL HEALTH DISTRICT // E..H. 13 24 1-'68 Rev. 5M