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FOR/' ..c USE: APPLICATION FOR SANITATION PERMIT ................ _------.- (Complete in Triplicate) Permit No. ..7/--0 Q "" ..... .. .. . ---- This Permit Expires 1 Year From Date Issued Date Issued 4_2-.-_A_-..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 ..-... a..s`�� -/%l�1 jl -.-o�-f/CX_foA/CENSUS TRACT .... -� Owner's Name ---_ ..--- - r / � r...e.. ........ <c.wo_e. /i ---------- -------------- /� -..... - .--._.Phone � Address .. ............. . -- ti._Qm-'t.�......- - - ... _....--------_._............... City ... Contractor's Name _-...._.- .. -„ ,_ ,t�Q�- !� - "1_11-------------....-----_--_---_.License # 17077/..... Phone .............................. Installation will serve: _...._. Residence rl Apartment Harr�e•n r.../...Q ':7r Contract l:: SII-in.A � t l Z I License No. �3 Z�Phone _ .. . ._...__. `- _- uarooge Grin er _.-__VP_- Lot Size .- ..tt-c�-,�-� Water Supply: Public System and name -....-..... ---------- --- ---- ._...-._...._ ---------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam n 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-ALLAT� (No septic tank or seepage pit permitted If public sewer is ava�able within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK- ' i l Size-..7d9cp.-_ ..S.Cd/e�,�_ Liquid Depth l Capacity L�OO��f-. Type -aJr °�% fMaterial..�nR� e J No. Compartments ---------1......... Distance To nearest: Well �_._-.~.�ff�: � �` �+/ .--r..�j.._4 Foundation _/4 -r- Prop- Line _ 1'.71 ,�(l-,$ LEACHING LINE [ ] No. of Lines -....... . ' ; Length of each line.-_..__.9� - v / ._. . Total Length ..�l Q,-- -. _ _ D' Box _....�_._ Type Filter Materia177G..(� Depth Filter Material .._.._. ._�. -------- Distance to nearest: Well SQZ7,/pl�C,f Foundati n IdyV V �T'-�.� ... Property Line j101r� SEEPAGE PIT [ ] Depth _--- ---.---------_ Diameter .---- ---------- Number ................. .......... Rock Filled Yes ❑ No Water Table Depth ----------------------- ............--Rock Size ------------------ ❑ Distance to nearest: Well ....... -----------------_---_.-_-._--Foundation _..__...------- Prop. line _...... - REPAIR/ADDITION(Prey. Sanitation Permit# ..-.......... .... .... ... _. ..... ........ . . Septic lank (Specify Requirements) ._._......................... ' Date - ------------------------) �J - Disposal Field (Specify Requirements) ----------- ---------------�-,�-'-_--- - -�-�� H .-.......-�.�j�-----��xG /J2Z6 -------- ....- . G O.,z . R (Draw existing and req.ired addition o "verse side) - ;;t 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 perenit is issued, I shall not employ a as to becom,eys/uble�t to WorkmaA/ 6omazensaHen laws of California." P Y nY Person in such manner Signed ..1.�,,./ - ��((f�///�..� Owner By ... y.. _. Title -A"V - - .... er t an owner) - ----�� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... ....... / BUILDING PERMIT ISSUED ....... - - "eer ----- --------- - DATE ..... ?...y - .._..-...... ADDITIONAL COMMENTS ...... - --------.-. --- ---------- - --.----DATE --- --.................. - ..................... -------------------------------------------------- - -- . ..... - -......-..... ------------ -----__------- -- -- ---- --- -- ---------- Final Ins . ection b -- ---- . P Y ............ . �- -�- --- --- . . ................ - -- - .. . . .--------.....Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M f C(;