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FOR OFFICE USE: 349_.7 >*,OPLICATION FOR SANITATION PERAy (Complete in Triplicate) Permit No. .-Z .-/..0. � - --------------------------- ---------------- ---_. This Permit Expires 1 Year From Date Issued Date Issuedn.�.o??-?Y 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 ADDRESS/LOCA ION// _--. .cY/LGA----------------------------------._..._.- ..CENSUS TRACT ... Owner's Name 7?L-----C."7..4 C [�L ... .................................. Phone .-... Address . L1�2- 6_v �N-N../Lam{ /2�------------------------ City '4a%`l/ Lir -------------------- ' #9--- ,+7� -1 - -/----- - - --------- -------- --------------•-- Contractor's Name -' - #c -... - :.. -- --- _ ------ -----.License Y3 d..-_ Phone 0__�_;W� -.. Installation will serve: Residence [FApartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other .... .. - ---------------------------- Number of living units:.__-.-_ Number of bedrooms __ -..Garbage Grinder .__._.--- Lot Size ./ / G` -............... Water Supply: Public System and name __....._-_-----_--------------_ .--_--_-----.._..Private Character of soil to a depth of 3 feet: Sand�2- Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _.. ....... If yes, type -----.-------- -----------_. IPIot 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 [ ] SEPTIC TANK 1 ] /Motea[ Size.- _------_--------------- __- --._...-._ Liquid Depth __.........-_... ... Capacity - ._____..-._ T _...--_---.. . Material-...__.__ ---. --. No. Compartments - - ......... Distance to nearest: W ----------- - -------------_....Foun tion ..._.__.._. ------ Prop. Line .--__-...-..-----_- LEACHING LINE [ ] No. of Lines ------ _-------- ngt of each line. .. ___-__ _ -._-. Total Length . - �J D' Box ---__..-.. Type File al ___---_--.-_.---- pth Filter Material -. ------------------_... .. ..Distance to nearest: Wel ._._-._.-_. Founda ion - . __ -_ Property Line _...................... SEEPAGE PIT [ ] Depth ...-__...__-.--- Dia _......_..... Nu er - __-__ .._ Rock Filled Yes ❑ No ❑Water Table Depth .--.-- ---._--------.._.. .....RockSizeDistance to nearest: Well _-.._.----_...... .......Foundation __..._......-- .. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -- ----- _---------------_. ---- --------- Date ...... ... .......................I Septic Tank (Specify Requirements) -------------------------------------------------- Disposal Field (Specify Requirements) ----- --- --------------------------- --..- ' 4V d- ! 4vl -e 4•<f?r e---------------------------------------------------------------------------------- ifaz�r c .✓d. /. . /fit<`v`--.. v (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: "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 22Z man's Compensation laws of California." Signed -. . . . . Owner BY `if - ,� Cr'�---- ------ .. -- . .. . Title . (If other Than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -.-... -- - -------- - - - -- _----------- ------ -------------- -------------. DATE ... e_.--�J.ZZ...... BUILDING PERMIT ISSUED - - - _...--.._. _------ ------------------------------------------DATE ------------ --------------------- .. ADDITIONAL COMMENTS __.................................... ......... _............... - ......-... .-....-........-...... _... ................ ------------------------------------------------------ ------------------------------------------------------ --------- -- .._.......-._..._...... ti2x -.. . .. .... - ------ --- - --- -Date _ �---------- Final Inspection by: . . . . SAN JOA UIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M