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rvx vrrtcx'ust: APPLICATION FOR SANITATION PE^MIT 1%�, *.We No. (Complete in Triplicate) "� - __----------__ This Permit Expires 1 Year From Date Issued Date Issued 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 eKtsting Rules and Regulations: JOB ADDRESS/LOC/ATION .-- _ -------- ,- _ -------L�/.7 4.41 t'(C*W.� NNi US TRACT ---- -'_?Jgr-�-O-- Owner's Namen-_y�T .r/=.. _I SO --�--+---� .'............. - ---------•.........�p Phone1',.1s9-.`1-..7._P7. Address _.--f__/.rzS6rR _ ? &l �J�.S 2� '.a.-.. City/1.1-Ab Contractor's Name ---1.7X,.OAg ✓---------------! _------ - ------•---------License #2s _33_P Phone � SJr Installation will serve: Residence Et partment House❑ Commercial []Trailer Court `Motel:❑Other--- ----------- ---------- ----------------- Number --------------Number of living units-.---/----- Number of bedrooms�A.....Garbage Grinder /✓P-_ Lot Size ------ Water Supply: Public System and name . -------------------_- ---------.........-.....................Private [T3� Character of soil to a depth of 3,feet: Sand A�'Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan ❑ Adobe❑ Fill Moterial _---------- If yes, type _-.-._---___.__--___-- (Plot plan, showing size of lot,-location of system in relation to wells, buildings, etc. must be placed on reverse side.) V NEW INSTALLATION: ._ (No septic tang or seepage pit permitted if ublic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Jr' Size_ ,.Z��_p=X - Liquid DepthP 6N Capacity �<�0(9_-__ TYPe)� .. Material_ : No. Compartments Distance to nearest: Well -- --------------------___- --Foundation /Q.-----.__ .... rop. Line _5----------------- LEACHING LINE [ ] No. of Lines .___--___-__._--_ 'Length of ch line--_-___--_-__-,_-.___- Total L th 'D' Box --_.----_-- Type Filter Material _--- ----------__.Depth Filter,' Material .----- - - 1 Distance to nearest: Well -----,-_-------------- Foundation -._---____:----__.___ Prope Line ........ . SEEPAGE PIT [ ] Depth -------------------- Diameter Number Rock lied Yes 0 N Water Table Depth r Rock-Size-.- ------- _ Distance to nearest: Well ...................... ....__.____Foundation _..__.- p. Line REPAIR/ADDITION(Prev. Sanitation Permit# ....... .._-_.----------------- ---------_ Date Septic Tank (Specify Requirements) 7{ ,$__J ................. Disposal Field (Specify Requirements) .PU..!Yf_P_.-4-------LfL.KFIA�1 ,------—421A 40-0-e 16o---_-$67PTLcr_._. --____. WK------N*7101-1------- - 42047-----6t1( ....... _60AIt:T_.-._-PR—a s"r- 1"A.NK- .CQNI c Tom... -Ext, 6'rt NC-- 4EAct4 • - - (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 certifies the following: "1 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 _ - Ow ner BY _. _. , .i I .. ' . Ylkle tf (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Bf -_ i --/. --- DATE Z2-6- BUILDING PERMIT 15517ED -__.__- - ` '- - ADDITIONAL COMMENTS - ..... ----------- ------------ - - - - - DATE ..... -------------------------------------------------------- - - -- ---------- -- ------------------------------------ ------- --------------------------------- ------ ------------------- -- '----'----'-- ------------------ --- - ----- --" ------------------------- - -- - - - -� -. ..- Final Inspe - - ----------- --------------t------- f - - - - - - -- ------- --`-------- --------------------------------------- -- -- - ---------------.Dae .- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M