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.......... ............ APPLICATION FOR SANITATION( PERMIT .......... . . . ........ (Complete in Triplicate) Permit NO. ._;.......... ........ _ This Permit Expires 1 Year From Date ate Issued ._.....: ... %pplication is hereby mode to the Son Joaquin Local I-lealth District for a permit to constrict and install the work herein .1escribed. This application is made in compliance with County Ordinance No. 549/and/existing Rules and Regulations: JOB ADDRESS/LOC-AATTION�T(p3..1e2.--..//.Gil. �j�/JLo......... C.A.LO�! - CENSUS TRACT ..�� .... ......_. Owner's Name T.oB....-�.4 uS1.... ...................---•• ._..._,.... .. .... _....Phonee?3-?' Address - 4S a-_.el�OtJQ�.-_.._. ... ... .. city Contractor's Name .e,5_ ,/t -------- #,.457' 'X?Phone :111 - Installation will serve: Residence)KApartment Houseo Commercial OTrailer Court )] Mote) ❑other-_-------------------------------------- Number of living units:.. l-.--_ Number of bedrooms _.....Garbage Grinder ....✓. Lot Size ........... Water Supply: Public System and name ....Private Character of soil to a depth of 3 feeti Sand❑ Sitt 0 Clay ❑ Peat 0 Sandy Loam Clay Loam 0 Hardpan Fer Adobe E] 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 seepage pit-permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK I jgjSe ;?..O- ize------IiF .............................. Liquid Depth .......................... Capacity JbO--------- Ty 9i?Z' Material---_----------------- No. `Compartments A...... .._. Distance to nearest: Well ......�1 ? ..................Foundation'.lQf_._......_ Prop. Line ... `.-........ pp��RLE CHI G LINE [ ] No. of Lines -./_............... Length of each line_-.-7,.}.-----...---- Tota) Length ....7. ;.................6 'D' Box ._._ ---- Type Filter Material/1474- [ pth Filter Material .-,Z.Y*...................._........ Y) Distance to nearest: Well .....5-07------ _ Foundation -.__.(#!.t.......... Property Line .............6 [ ) Ghefl -- oklmoer - Nvmber Rock Weed Yes Nn Q Wntnr Tnhin t>a*+th _. .........................._... Aveh-6if0 .....Dissewee . ell ------........... ....................Fouttdsstlom_•----•-•----_-_. Prep:-kNta ------•-• ....... ' REPAIR DDITION(Prev. Sanitation Permit-#y-----.............. .......................... ) fi Septic Tank (Specify Requirements) . _./-. �'!.-..GYs `- f�• . r.................................-..----.........___..------....P� Disposal Field (Specify Requirements) -----------------•------------••--••4.......................................... ._. --... .......... ..... .... ...... -- - --._._..-.........__.....................-----.... ------- _.. ._.-... ------------------------.............................................................................._........ (Draw existing and required addition on reverse side) y 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 become subject to Workman's Compensation laws of California." Signed _ �1�J a i(J. . . .. - --- - --------------------------- --------------- Owner _.��... _ .'t'--- Title -' - -_ (It other than owner) FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... - -- ee -----------------_ DATE .J f .. ........... BUILDING PERMIT ISSUED -----------------...-_.------- - .DATE - _ ..----------- ._..... ......... DDITIONAL COMMENTS ._ _. ..................... _.. - 7'�..�i �.. ..... - .. --..___ - .. . --------------------- -- . _. - - _. Final Inspection by. .ev_.�o .. ------------- ---------------------- ._ -------------------..Date . .......... EH 13 2(r 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3K