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' FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT � 6� X09 — PermitNo .......":._-- ..t_ (Complete in Triplicate) • .. -- 2 �-- Date Issued This Permit Expires 1 Year From Date issued c ' Application is hereby made to the San JoaqulA-Lo'Eal Hrsnith distri'd'for. a permit to construct and install the work herein described. This application is ma a in comQpliansC with C9unty O�naa�e No. 54 a xisting RUI and Regulations: oze JOB ADDRESS/LOCATION CENSUS TRACT '._--.---_ -............�,1 . ... -- Phone - - Owner's Nome .. e Address - ' ' Jl a ................................A............... City - ... - �� . :............. � p 7 ! s2..Licenso # ..�.88_�x� . Phone .............................. Contractor's Name .... ` ed---- - -- ' Installation will serve: Residence 0 Apartment House❑ Commercial oTrailet Court 0 Motel ❑Other-------------------------------------------- Number ------------- ------------------------ Number of living units:..... ... Number of bedrooms ..._...Garbage Grinder Lot Size ..- --------- Water Supply: Public System -and name ............................ ....t ....._...._......Private (� Character of soil to a depth of 3 feet: Sand❑ Slit CIaY E] Peat Lf] Sandy Loam O't Clay Loam,D ' Hardpan ❑ Adobe 0 Fill Material ------ ----- If yes,type .--- �'---'----- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: (No septic tank or seep ge pit permitted if public sewer is available within 200 feet,► PACKAGE TREATMENT [ ] SEPTIC TA { Si es -�.1�(D_�a. �.............- Liquid Ddpth -ct�-------------:...._ rQ- r « _ �— aP... T ^ " .--. Material..X... ' No. Compartments .._,......�----..... Capacity ...... ... YP t Distance to nearest: Well ..._..../. 4._�••.. ......Foundation _..... f? - ...... Prop. Line ..... S. `•� '.._..! Total' L ngth [ 1 No. of Lines --------'S - _..... Length,of each line............ ( _....... D' Box . Type Type Filter Materiol;_:.r!_�; --_Depth- Filter Material ..__._...,!.�--............. ---••- Distance to nearest: Well /-OH..-F_Fbundotion .---': .0.4-__._._-- Property Line ... �'....__....----- C SEEPAGE PIT I ] Depth ...--.•... Diameter ...........:...: Number ..... ------------- Rock FI Yes (=7 No ID ' Water Table Depth Rock Size ................................ Distance to nearest: Well -....................... Foundation Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .......................................... Date --------------•-----------• ) - -- - -- Septic Tank (Specify Requirements) ------------------- ---�-----.-- - ---- / ,ja i Disposal Field (Specify Requirements) ...... /.. ....... .....=.........-••-- ------- ............... - _... 1 - - -......._... - ._. . - ----- -....... •--------'- - - ... - - -................................ -•.............. •�. (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 Regulations of the.San Joaquin Local Health District. Home owner or Licen- sed agents signature cortifies 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 become subject to Workman's Compensation laws of California:' . sL2tt By Signed ............._.(3 _.....:_....... Owner tl\•-P✓AZ,.ra.F-• . e ._.rf.il :C - .................................... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._, _ DATE .L.?-..Zy'n!sir...... •- - - - ......._ - BUILDING PERMIT ISSUED ------.---------........ --------------------------- .-................ DATE................................... COMMENTS._.......--...---------.................................................... ...... ..... ..... ::..... - - - - - ..................... - ......... - ------------------------ ----------- ------------- - - ..----------•-----------------------------........... ................-;----...----- - --------------- - �. - - - - -- Final Inspection iw- - - - •• --- ....__._......_...._.................. _.............. ......-.Date . - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. SM,