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FOR = USE: APP� Permit No. ...7 ATION FOR SANITATION PERMIT �..i _ . ' � �--�-�--�---� (Complete in Triplicate) .. ._./-..rr.�.7 _.._ .. .......... ........._ .............. . This Permit Expires t Year From Date Issued Date Issued . -..7 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/LOCATION _� 3 A /.._ .- _'_ . l/<tC%�r?JGL__ J�O .�---tJ)-QC 01V-..CENSUS TRACT ---- ............ Owner's Name -------------_-------•------- ----- ------------- --.Phone .`��-.U.�.?�5 Address . - --- - ------- Q/n1.P -- -------- /.. ---- ---------------- ...._.._.. City 1J -------------- -- ------------------... ....... Contractor's Name ----- 4-1----j I/W_0_r7-4._-----------------------------._.License # 170771---_ Phone -------------------------- Installation will serve: Residence ❑ Apartment House❑��C'oommerciia/al ❑Trailer ourt C] -` Morel ®Other _ v �e__/Lo6%�t7��tnF� `?'Y6O' / Number of living units:.-._____ Number of bedrooT s .......Garbage Grinder ....N9.. Lot Size ------ --------------- 14 Water Supply: Public System and name .--.--- ------------------------------- ----------- ------------------------------_........1.........Private [� Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe X 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,) U PACKAGE TREATMENT [ I SEPTIC TANK[ Size.._?---7 _5X8�n Liquid Depth Capacity/_47Al:._ Type'A%F` / f/'Material__CoVLc No. Compartments .___... ._._..... Distance to nearest: Well ------ _Foundation .fOrl',_idl f- Prop. Line LEACHING LINE [ ] No. of Lines _____ ._ Length of each line_ Total Length �1-------l----- 'D' Box ... Type Filter Materials __.G. Depth Filter Material ....._S._l... /�� / Distance to nearest: Well SpF!�l_r. Foundati n 1O�0tLs_. Property Line j_-RJ . -P. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number _----_----_-------------- Rock Filled Yes ❑ No C] r Water Table Depth ----------------------------------------------Rock Size ................................ Distance to nearest: Well ........................................Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .--------------_.___._..._._..._._---- Date ----------------- ................) Septic Tank (Specify Requirements) -------- ------------------ ---- - - - — - - --- - - - - ----------- -- --- -- _ _ Disposal Field (Specify Requirements) ----- _...L1P..JG..--._. _C�LXAV----- /1214 /�e11/7l?�i -- --------------------- --------- - -----r---- -- .fer-t..--- _.�. . /.� (Draw existing and req ired addition on,�everse side) hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin =ounty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- ;ed 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 is to become su lett to Workma ensation laws of California." ,igned -`.. - -- ----- ---- Owner iy ........> - - ----- . -- - ---------- - - --------------- Title ----A X- --------------------------_._.......__...------ r than owned FOR DEPARTMENT USE ONLY Of APPLICATION ACCEPTED BY -----------Lld;z---��, - - ....rte' - - ------------------ DATE _ /0 -�'� �---------------- WILDING PERMIT ISSUED ----------- ------------------------ - - ----------------- - ------------------------- -DATE . .. ---------------------------_- - --- - - --------------- >DDITIONAL COMMENTS .....---...........................................................................................................- - .... .............................. -..------ --- ----------------------------------- ------------------------ --------- -- ------------ --------- ---- ---- ---------------------- ----------- -- -------------- -(nal Inspection by: -------- -- - ----------- ---------------------------------- - - - -- Date ..�.2 �S �----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT :. H. 9 1-'68 Rev. 5M C