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FOR OFFICE USE: ,aLICATION FOR SANITATION PERM" / // Permit ' 6- L. 0 (Complete in Triplicate) ---- ---_ ---------- --------------------------------- This Permit Expires 1 Year From Date Issued Date Issued .� 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. /��__7QV_,.-�__-___ PN_F__Lh��-_--_--_-_CKPA,C.�-.CENSUS TRACT ._ __--.-_---__--- Owner's Name ----------..M i�_-------6RI_FF/-'-/ ..:..........................r-------- ----------Phone _,$y7-.Q77k?_._-. Address K.W-3_(37.04 -�---- L_01,1_FT�'_ � ------R -- -------- ------- A---. City _C Lit=------------------------------- ---------. Contractor's Name OLV. E F-,� - — ---- - ------ - ---- --- ----- --- --.License # ---- -- - ---- ----_ Phone ------I will serve: Residence ETXpartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other------------------------ ..... � y, Number of living units:__1___. Number of bedrooms _.._.Garbage Grinder _----. Lot Size ------------ Water Supply: Public System and name -------------------------------------------- -----------------____------------------------------------Private ❑ Character of soil to a depth of3'feet:' =Sand' Silt Clay Peat Sand Loam Clay Loam P ❑' ❑ Y ❑ ❑ Y O Y L __ Hardpan,R�Adobe❑ Fill Material Vo-r--- If yes,type -...__.--.._--------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) c NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) C PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size;.',; ._.___--------------_-_-__________ Liquid Depth -------------__.__._--__ \ Capacity - ------------- Type -- -- --------------Material-------- -- -------- No. Compartments .-----• ............. Distance to nearest: Well _--._--_._._____-__-____.each ___Foundation __________ ---- Prop. Line __-- LEACHING LINE [ ] No. of Lines _________._.- Length of ch line-- -- ---------------- Total Length ------------ P 'D' Box --------- Type Filter Material -------- -----------Depth Filter Material ----- -------------.--------_.-........... ` Distance to nearest: Well _------- ------ --- --- Foundation ------------------------ Property Line ----------..___-----.-- n SEEPAGE PIT [ ] Depth ---._.._---_------ Diameter ------ ---_- --- Number __----___ ------------ Rock Filled Yes ❑ No ❑ 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) -.J? PLRCJ`-------1=X15T/n(6Sl=P7tC _-MANI S wj:rJl- ►zoo �f►�• -.ca1�r ► �r ----- �RNk -------DISI- -t`�oX . _ rs,�� . - prsr . -. S_lslirv! " �-1>t�n[._ c►t-�Nom'- �o t --- �XB- �� ` Ptr (Draw existing and required addition on reverse side) 1 hereby certify that l 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 Son 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 become subject to Workman's Compensation laws of California." r Signed /-----------�--�-,-,-,-�-- ------ - ------ - ----- - - ------------- Owner 8Y --/--J -`° Title -- -------- ----------------- - ------------- - ` (If other th owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t �----------------------------------------------------------------------- DATE --- `.G. b ----------- / BUILDING PERMIT_ISSUED - - - - ) ----- - - ---- -- -- ---- ---DATE ..-----: -------- ---- A- DDITIONA-L--CO- N---TS -------- --- ------!--- - , - - -- - ------ - -----: - /--- -- My - f -'- -- - - 4-- -- ._ - _ - -- % - - : - Final Inspecti - - Date - SAN JOAQUIN LOCAL HEALTH DISTRICT ` E. H. 9 1-'68 Rev. 5M