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I . FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No 7`�'"•..-....., (Complete In Triplicate) / .. / ...........................•--• Date Issued /G; Tri p 'this Permit Ezplres 1 Year Frown Date Issued f - .. ........... ........_..._._ .............. q herein Application �s herebymade to the San Joaquin Local Health District for a permit to to and instal! the work. described..This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . I'.0� .... . . -� ��'• ... . ........................CENSUS TRACT. . , ��... ,t/ _......_.. Owner's Name ...1�L e- �i• .!.r:?.. i1.=�r..c "!] ............. yj s• / / f Phone � fd Address �// rt 27:.�.�.�...ec'�t ............... # .. Cry . _- { Cantrarfor's.Name ._ nse _..._.-.Lice Phone . .............................._._....._....__.....__•__. ' Installation will serve: Residence 1�}Apartment House C1CommeP rcial[]Trailer Court 0 Motel ❑Other..... Nu --------------------------------- x -Number of living units --- ..... :_..:.Lmber of bedrooms :3•-•.••-Garbage Grinder ..:....:._.. Lot Size y Private yst_m and name ------------------------------------_____________ ___._.......___... Nater Supply. Public S Character of soil to a deplh of 3 feet. J- Silt❑ Clay ❑ Peat❑ sandy Loam[JClay Loarr,� \ y Hardpan A� Adobe [I Fill Material .......if yes,type............... � t (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION:- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ( ) Size_.......................... ...... Liquid.Depth -- PACKAGE TREATMENT, I SEPTIC TANK t Type Material...._ No Comportments 6, -capacity .................. -- , ? Distance to nearest: Well ____________________________________Fours Pro Cine dation h z „.LEACHING L1Nc L j Length of each line Tat leng ' No. of Lines'.-.-•.................._ ........Depth Filter Material I k ` D' Boz Type Filter Material s .._._ " } Distance to nearest: Well'................•_-••:-•'Foundation Property Line Diameter ..--•.. e. SE:PAGE PIT Depth t Numb ell a Water Table Depth •--•---•-..._Rock Size....... Rock Fill Yes o _--• ---- --------------- Foundation .... ___.. Prop. Line - .. i Distance to nearest: Well --------------.--•---••-• REP . s Date'..., ------•-- . . AIR/ADDITION(Prev. Sanitation Permit#.....__..:____..-.---•_-.-• Septic Tank (Specify Requiremerts} _-----.---•-----------------:_ -..__..._......__.:. �.v/✓ c ��.-tax^: rid ' 7 s.._�_1 ��raf+�.,lr' Disposal Field (specify Requirements} .�_« �� -- •-•----,-• r ........................ ` .. . ...... ................... .•--•----•- ..__..._....._..___._. ...._... .......... -..... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared !i application and that the work will be done in accordance with Sart..Jacquln County Ordinances, State Lows, and Rules and Regulations of the San Joaquin Local Heailh District.Home ownar or liten- sed agents signature certifies the following. "1 certify Ihat in the performance aF the work for which this permit is issued, I shall not employ am person In such manner as to becomer subject to workman'sXempensation aws of California... Ls GtC.l....:_...............Owner ' SigneCG= l/ ...... ......... ................. ...................... •.................... ... Title (if other than owners __ ; FOR ----- � .............. DEPARTMENT USE ONLY _ — ........ DATE.f�:`..,. . ._.� APPLICATION ACCEPTED 13Y .%/ ;,r/ L-e. ;.�..._._:- ._._ _._____:...-_.._._...--.___ �-�--- •-------•---•--�---DATE.........---�---•• ................... BUILDING.PERMIT --.'......-,- ----------- ---- --------•-- fiLI1LDENG PERMIT 15511ED.....-_.._.. :....:.. ADDITIONAL COMMENTS ......_.•._.................... ..... ....... .......: ....I....................... ...... ...... ..... .. _...._... ::._. Date .. ...... ............ Final Inspection by: SAN JOAQUIN LOCAL itEALTH DISTRICT E.H. 9 1-'68 Rev: 5M