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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7l' S 1 - r ......................................._). ..._.: Permit No. ............... (Complete In Triplicate) ........._.-.:................:.:.................. _ . Date Issued-v4—/4-25 ......... . .........................................I........_..... - This Permit Expires f Year From Dablssued - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESSACICAT N ..�`/ ....� .,F-`d'... ..................................CENSUS TRACT ......... Owner's Name . .P. / .R`C.. f2.�r ......_.._................................:.............. .Phone ...........................:........ �drest . . , -_....�...............:............. .,, ..........................CityWJ................./.�........................... Contractor's Name...... Q.l-{�1.- �l��ra✓i ............ ........License iY rnr[c-.�� Phone4.- Installation will serve: Residence Apartment House Q Commercial OTroller Court 0 / Motel Q-Other..........g .................................. Number of living units:..-1...... Number of bedrooms V.......Garfiege Grinder I&O.F. Lot Size 67,012-`W�2 - -v............... Water Supply: Public System and name ...................------:m............................................... ._____........................Privale� Character of soil to a depth of 3 feet: Sand 0 Silt Q Clay Q Peat Q Sandy Loam Q Clay Loam 1-1 Hardpan Q Adobe M Fill Material ..._....... If yes,type ........................... (1� [Plot plan, showing size of lot, 'location of system in relation to waits, buildings, etc.vmust be placed-on-reverse side. NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,l . PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size....--------------------_........... � . liquid`C41h .................. .._. . . Capacity .................... Type ........-......... Material.......i......... ./No.,Compartrr+etts .................... Distance,to nearest: Well ...___1 ............�..Foandation ............... ...„ Prop..Line...................... LEACHING LINE [ J No. of linea _........-•---_-.--:-Length of sect fine............................ Total Length .............._............ 'D' Box ............ Type Filter Moterral .....:::............Depth Filter Material .-..................................._..... Distance to nearest: Well ..............._....... Foundatlon ..-..... ................ SEEPAGE PIT [ J Depth ..... .. Diameter .::.�L......_ Number ...._....=............. Rock Filled Yes Q No Q Water Table Depth ... '......................_......._........Rock Size ._._,..7...................... je Distance to nearest: Well .................. .Foundation .................... Prop. Line ......._------..... REPAIR/ADDITION{Prov. Sanitation Permit. .---..........r.__....................... Date .................................I i Septic Tank'(Specify Requirements),'.......... ...... .. ....._............._.............. .. i . Disposal Field (Specify Requirements) -- r�d -'• f �� -• "� � """"' .. . - ..................................... :-_......._:................---••---..._.1, ........ ............. .............. ----------------------------------- --•-•-•----...------ .........-----•- ...............,................ I '[Draw existing 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 Son Joact'uin Local Health,District. Herne owner Of Ilcen- sed agents signature certifies the following: ------ - rf "I certify that in the performance hof the work for which this permit Is issued, 1 shalt not emplay any person In such manner as to become subject to Workman's Compensation laws of California." V �+ Signed ........ .... . Owner By .:.: - - Title - . -- •other thou owner] FOR DEPARTMENT USE O LY APPLICATION ACCEPTED BY...,:.: - .............................. ......................... DATE ....�3 .-�L. z .............. BUILDING PERMIT ISSUED .............................. .................i..........................DATE ...... ...........................I..... :.._.. ADDITIONALCOMMENTS ...............................................................................................................1. ..... ................................... ..........- •................•----.............--•--•-.--......_.........•-----........•--.._....•.. .............:.............................-............................... ........................................................._•_-------- ...................................................... ........................... _. v .... ..,.'. ..... ............... ��99 .. .. Date .. Final Inspection by: ... ....... ... .....t:l.._.-..1:-.�`....._........�......:�. -........... .. . ._ fell 13 24-a tj...lfei!.-514 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/71J 3M