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k i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --- ---------- - Permit No. - -- � �_ __... _ ._, l. . _... .,._ .. .__... -—_.M w ..,. - " "" "' Complete�n Tr�pl�cate) ---------- -------------------- Date Issued --------------- This Permit Expires I Year From Date Issued Applications is hereby made to the San Joaquin Local Health District for a permit to Onst`ruct and install the work herein I described. This application is made in com fiance with County Ordinance N,,o./5d9,and exNfin;g Rules and Regulation JOB ADDRESS/LOC _ - 777= ` ��G- " / G' k� CENSUS TRACT --- =- •4 __----- ,r� ------------------ Owner's Name ------1.e- � �' ---------------- :' Pone Address -- ---------------- --------------------------------------------- ity , ----------------------------------------------- --------- -�----- 1 ---------------------------------- l /� �� _n --------- ---- --License # ---------:-=------------ Phone -- ------------------._...---- Contractors Name .. j �` l-e� - Iy � Installation will serf Residence Apartment House 10 Comm1ercial ❑Trailer Co-.rt f❑ Motel E]Other ---------------- ----------- --------- Number o living units:. _.(Number of'�bedroomst,�--_--Garbage G�rindery��-- Lot Fze �-_rwev�&----------------------- Water Supply: Public System and name __€,;._> /�J_ � rf'/_ ----------Private ❑ It Character of soil to a depth of 3 feet: San E] Silt ❑ I Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam 'D Hardpan ❑ Adobe , Fill Material ------------ If yes,type -----------Af-------------- (Plot plan! showing size of lot, location of ysteF�in relation to wells, buildings, etc. must�be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sew is availablwithin 2QOifee#,) i i ,�9,� liquid De th _ PACKAGE TREATMENT, [ J SEPTIC TANK' j m; j Size---- - ---- - ---- -------------------------- 1� ��------- -----.----- k Capacity � ___ Type/40� jO/__ Material-CV&_e-_j1----- No. Compartments __ ___...._____ ------Foundation Pro Line i�T�- ---- ---- Distance to nearest: Well ___._.�_ _��__-�______ ��-------I.--- p- LEACHING LINE No. of Lines _.__ ___;___ -__ __ gth of each line � - Total Length _____________ en 'D' Bo;eyt: - - T e Filler Mater.,i_al Depth—Filter,Materiaf -1-0/61117` ___-------------- =------------ Distan near91est, lel) ----- ---__ _ .Folin cition __,�` _---:_..____ Property Line __ ____________________ >t 1 ..gg , = f ___---___ Rock Filled Yes ArNoDe t� --- .-s�'�-- ---- Diamet` �*�- , Number _ .��___- �7 SEEPAGE.PIT, �] � p - ----- Water'Table .Depth"` .� A ._-.�, .-_Rock Size ' '------------- r 'r A Z Distance to 'earest: Well _------_`""fir'__________________Foundation _p�-to._� -___ Prop. Line --� ------ REPAIRfADDITION(Prev. Sanitation Permit-#""""�"' � -) --------------- ------ Date-•--------------'--------- - SepticiTank (Specify Requirements) ---------- ---------------------------------------------•- ---------------------------------------------- - - .f 1 Disposal Field (SpecifyRequirements) -----------------------------------------------------------`------------ ------- ------------ w ---- ---------------------- i ---------------------------------------------------------------------------------------------- ------- ----- ------ ----------------------------------------------------------------------------------------------- I - (Draw existing and required addition on reverse side) I hereby,certify that I ha v prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State flaws, and Rules and Regulations of the San Joaquin Loral 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 emplo any person in such manner i t as to become subject to Arkman's Compensation laws of California." I Signedj------- ------ ---------------------------- ----------------------- Owner BY y 7i fe --- - j1/x-r (If other n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C7,---. - --- -------- ------------------ ----------------------------- DATE __f©__ "_.70---------------- BUILDIOGPERMIT ISSUED -------------------------- ------------------------------------DATE ------------------------------------------ ADDITIONAL COMMENTS ------ ---- ------------------------------ ------------------- ----------------------- -- - -------- ----------------- ---------- ' ------ -- ---------------------- t' ��-------- - -------- - ±-(I---------------------- -------------------------- ------------ - --- p---------------------------------------------------------- ----------- M---------------- - - --__------------------------------------ ------- --- ----------------------------------- -= .--- Final Inspection by: _ -__..: ---� -- ------ -- -----------------kid--- ---------.Date -- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M