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FOR OFFICE USE: App CATION FOR SANITATION PERM' ................__._..........--_------ � permit No. -.],1_:s.7j.. (Complete in Triplicate) .._,___ ----------- This Permit Expires I Year From Date Issued Date Issued ._...:........:....L Application is hereby made to the Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiprJ ih p i compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .r}_.�_./4.$.f..._, ..I._.V_ _1R� _ -f_J9> .------.._.-....__..-..-_--.CENSUS TR/�/ACT ..S.yp.�r.............. Owner's Name --�'.R- �-fiG P-�-=M '------------------._. ----............._ .......... _.Phone-F5 !� t�� a� _ _ . 9 ---------- �y } 36 Address -- k -f -v------------..........................y..+_-------------...------ City .G_�..�-rn-*02.--.....CAA--J I------_-----.--_-- Contractor's Name .,/K o- -/-.V.-R--.. -J�.f?'�.� �s...l._M../),Cli-.SW icense # .A.4.0-9 X.y Phone 16 VY-1-46.-C. - Installation will serve: Residence(Apartment House❑ Commercial pTratier Court 0 Motel ❑Other........................................... ��tt Number of living units:----�-_._- Number of bedrooms _3-_-_Garbage Grinder ...Q___.. Lot Size ...2__5_P.-2.4;_t1...... Water Supply: Public System and name - -------------------------------------_.._------..---.---- _....--...._... .......-....._.._--....Private FO' Character of soil to a depth of 3 feet: Sand t] Silt❑ Clay [R" Peat❑r Sandy Loam 0 Clay Loam ❑ 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,) r PACKAGE TREATMENT [ I SEPTIC TANK{ l 5i -----J �_fib-...GrxQ�y--_----- Liquid Depth .... Capacity 126A.-... Type - - 6Tioff.-_................ No. Compartments Distance to nearest: Well - S_ja.-Q-------_-------_Foundation --.._.__._-. Prop- Line...................... LEACHING LINE [ ) No. of Lines ..-„3.._..__. - .. Length of each,�line..__yArQ----.__._- Total Length l.,j.Q...-...... 'D' Box ..4.-,....... . Type Filter Material!..X..Z_ 2 _-�epth Filter Material ------_---Li�J/ Distance to nearest: Well _.3---- O /Foundation --- ------------------- Property Line .....-.................. SEEPAGE PIT ( J Depth Ad.'-._._.._\Diameter -1.3...... Number _.........3----------.-_ Rock Filled Yes 0, No Q �} Water Table Depth .---------------------------------------------RockSize 3 X-14. \tt Distance to nearest: Well --------------------Foundation ----------....-_... Prop. Line ...................... I REPAIR/ADDITION(Prov. Sanitation Permit# ../-_---_--....__-_._. .-..... Date .......................... _- Septic Tank (Specify Requirements) ............L._:"a,,._Q_.G.._.. ro__................ _ _ _______ _ _ _____ _ Disposal Field (Specify Requirements ..... - „p i - t , ................ .......................................... t - (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 otcordance with San Joaquin County Ordinances,-State Laws, and Rules and Regulations of the Son-4hsal(li in Local Health District. Home owner orliieen- sed agents signature certifies the following: \ "I certify that in the performance of the work for which this permit is Issued, 1 shall net employ any person In such manner as to become sub(ect to Workman's Compensntion laws of California.,, Signed ... .. .. -. . . ...__...-...._.... ................................. Owner BY . �._._ � :_.L._IJ.. Yale A.0".4. (if other than o rl MR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . . BUILDING PERMIT ISSUED _ . -------------- DATE of^.� :�_ ......-- ...... ' ......_...--.----- . .---...............DATE ... ADDITIONAL COMMENTS - ._--------. ...............-__..-------..-------..-.- ----- .............. ........ - in..._------- - .....-..__..------ Finallnspectionby: .` ,/ r - -- - ��' ------- ' -- ----------...Date d - . SAN JOAQUIN LOCAL HEALTH DtSTRICi E. H. 9 1-'68 Rev, 5M