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FOR OFFICE USE: APPLICATION FOR SANITATION P,,JIT (Complete in Triplicate) Permit No. .Z16.90 ........................................................ This Permit Expires 1 Year From Dot*issued Date Issued 6 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 1made in compliance with County Ordinance No. 549 and existing Rules and Regulationss JOB ADDRESS/LOCATION Owner's Name � . � -.. . ,rJ.. . } r CENSUS TRACT ........s..................... ............................................. . 8a, s ......` . Address .a 7.064...... .. ••. .. .. :......... i City ....:............. - ... .....-.. .... .............................---•---- Contractor's Name ..�1-�c..:_a... �.A� 11A .:..................................License #So$d�..�. Phone .� �.v._ Installation will serve: Residence❑Apartment House C) Commercial KTraller Court fl Motel ❑Other...... - Number of living units:- --------- Number of bedrooms ......._...Garbage Grinder ............ Lot Size ............... .................. Water Supply: Public System and name ..................................... ••.................--..._-.__........_......---•-----.......------...Private Q � Character of soil to a depth of 3 feet: Sand Q Slit❑ Clay Q Peat❑ Sandy Loom Q Clay Loom ❑ Hardpan ❑ Adobe ❑ 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 [ ) SEPTIC TANK .. ....... , + ( ] Sae......._._................... ...... Liquid Depth ......... Capacity .�0 �.... Type No.No. Com artments Distance to .nearest: Well ------ ... �-r r ^� (7A....Foundotion .J.6.......... Prop. Line ...-?V./......... LEACHING LINE [ ] No. of Lines ..'-?.... Length of each line....Z+f- ............... Total Length 'D' Box ------- ----- Type Filter'Materia[ ....................Depth Filter Material .......................... Distance to nearest: Well ...... Foundation ..... .................. Property Line ...................... . SEEPAGE PIT [ J Depth ...... ':........... Diameter ................ Number ............................ Rock filled Yes Q No Water Table Depth .._.._.. ..................... ...............Rock Size ----- ................... Distance to nearest: Well ........................................Foundation .................... Prop. line ................ REPAIR/ADDITION(Prev. Sanitation Permit Sac .............. Date .................................. ` Septic Tank (Specify Requirements) .--............................. ... __...._._._.... Disposal Field (Specify Requirements) ......�2SLST/.^ - .....5 j�TLC_---- Tjg-f�Y............... Cco. .g'------Tlt!9.N__...111.:`..-Ta.......��u�cpLN.� ...fJD.1J1..Tr.flN = .-......... .rf3�....... A.cH.WNCS,, ..........................--:.:_ (Draw existing and required addition on reverse side) 1 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 bec r��e b' to�,V(y�orkman's Compen ation laws of California." Signed ---I .-. Nt.^.. � - �� Owner By -- .. er-..th.. --- ----- II of .......................... title .. .. ... .. ..........................an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------------- DATE _lo 'Z�-.TF...........: BUILDING PERMIT ISSUED .---- - -- ----- - .... . ....................._.. /................_.....--- ....._ ..DATE . ..__................................. ADDITIONAL COMMENTS ......... .................. . .. ...... •-•-------------- - ...._.._...__.................._.._- _...__...._......-..-- -........-...' ............................................... . .........._ ....... . ..... .....I........ . _ . . .. ..... . .. .. ................................. ... . . . .............................. . _. .... .. Final Inspection by .. ................... .. ... .�f/(�--- ----- ............ ...... ..........Date _. �J•-� 6 . EH 13 2h 1-68 ltev. 5m SAN JOAQUIN LOCA EALTH DISTRICT 8/7h 3M