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FOR OFFICE USE: APPLICATIC;I FOR SANITATION PERMIT d 6.5.4.71... . . _. ...._ - ....._. (Complete In Triplicate) Permit No. . . ...-. Date Issued.. ..:.1.4.:..48 .. ...................... _ ..._.... ..... This Permit Expires 1 Year From Date Issued Application is herebv made to the San Joaquin Local Health District for a permit to construct and Install the work h6rein ,. described. This apglication is made in compliance with Co0y Ordinance yyttNO. /544,9�and 9yristinp Rule; a lot' JOB AD SS/L VO,N ...L L..�p u.it� /t[.�ts'r o +�!t. . SUS I7/yRrA ...._...._ . �-: Owner's q4-�W..k _ ._.t 0.��.............. . .. .. .. ............... Phony �T .�iZ�Ly..� ,tt 1 x.' Address .2.4100. . ........Cify.... _ �./ .5 bus g ne68:. ,6 '( Contra.tai s Names,.. .... f- 4. a- t......license#� e3 . . Pho •- : Installation will serve: Residence fj Apnrtment House[I Commercial ❑Trailer Court ❑ ^ `.. Motel D Ciher. ..._....... .......................... y Number of living units:_.------- Number of LedroomJ.......Garbage Grinder ............ Lot Size ......... Water Supply: Public System and name ........ ....................................-----------.........._.................................Private N Character of soil to a depth of 3 feet: Sand j] -Silt❑ Clay ❑ Peat❑ Sandy Loom K Clay Loam ❑ i y. Hardpan❑ Adobe❑ Fill Material ............If yes,type---------------------------- (Plot -----...._------(Plot plan, showing size of lot,- locaticn ofsystemin 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') yyy -PACKAGE TREATMENT [ ] SEPTIC TANK( ) Size..................................... ........ Liquid Depth ..................•••--• Capacity .-_. .. .... ...... Type Material......._............. No. Compartments ............._....`_ Distance to nearest: Well ._................................Foundation.,.........,-._...._.Prop. Line.............n....... , gygygy Pf LEACHING LINE [ ] No. of Lines ..._. ......... Length of each line- ._..... ......... ...... Total Length ..... ............... $ 'D' Box ....... .... Type Filter Material ...... ! .. .Depth Filter Material . ._......... ......._.._..... 93 t Distance to nearest: Well . .....................Y Foundation ........................ Property Line ...............�._..._ SEEPAGE PIT Depth , _ [ 1 P __._....-...._.. Diameter ................ Number....._...-............-.... Rock Filled...Yes ❑`moo Q) Water Table Depth ................................................Rock Size ..............._..-........ Distance to nearest: Well _..................................Foundation . ..... ...... ---- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ................... .............. ..... .. Date .................. ...............I Septic Tank !Specify Roquiremerts) - ---- -- -----' - --- /�� J� _/fig, __� �.�.�..�. D' osal Field (5 ecii Requirements) .- I-...: "•o"-='{....'....fD T��.�... ..1� W...........�.......��.r""'�'e cl . ... r ! ... ` ` r .a�Ca-....o•-C•G- . �i J ... .. ....!�f.....]�....e�.....7�...�/�-... .... r (Draw exilingand `. . . . .._...ever..."--"...................... ...-""'""..:......................:_` :equired'addttion on reverse side) I hereby certify that ! ho4 prepared this application and that the wore will be done In accordance with San Joaquin County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home awner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issueri, I shall not employ any person In such manner as to become subjecttoWorkman's Compensation laws of Coitiomia." Signed . .._../he ._ _. .. __ . ... 11.�.�By . ...Gay //tq�f . Title2915 E.Miner Ave., • HO.6.3841 _FORARTMENT USE ONLY APPLICATION ACCEPTED BY .�/�!'Ysr,.s-co'4� __........ __.. .. __...... DATE.�-1S-.. .B................. BUILDING PERMIT ISSUED _..._......_.. _ . . ..._.__ .DATE . . ...... ._.... . ...... ..... ADDITIONAL COMMENTS .. _. . . ._ .. . __ __._... . _.. ....___....... Final Inspection by: /i,�ii-r�ta�3' �� - � - - Date � SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M y �