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FOR OFFICE USE: ---------------- -------- ------------------ ------------- This Permit Expires.] Year From Date Issued Date Issued ------ APPLICATION FOR SANITATIONrF ';�„7 s -------------------- ---------------------- (Complete in triplicate) Permit No. ------"•----•---; ••---- __-."'i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereint described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _f O O- " �{--- / ------------R.[-P-01V-.CENSUS TRACT S1� Owner's NameYti/Y .% � Y _ ------- i-iY X/-----••--- �s �� ea ----- -------Phone .----------------- -- _i- - -- � .""-------------- ------- ---. City ------------ - Contractor's Name -------- t ---------.License # 164--s06 5 3 -- --�------- - "-- Phone Installation will serve: Residence ❑Apartment House❑ Com �WTrailet Court ;❑ Motel []Other-_fI?l?ltI-___QE!_CX P{gNS10N Number of living units: -_ Number of bedrooms--__.---Garbage Grinder-777=- - 1 Public System and name ------_-----•------- Lot Size Water Su "."-------------•---------- pp Y� - ------------------•------ ------------------------------------------------Private Character of,soil to a depth of 3 feet: Sand'❑ Silt❑ Clay 1 - y ❑ Peat❑ Sandy Loam Clay Loam ❑ I Hardpan ❑ Adobe ❑ Fill Material _Na-)_,_ If yes, t I (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,) PACKAGE TREATMENT [ ] SEPTIC TANK ] Size-.--- ----X--•�----X--��-'•------- Liquid Dept} `ter._ " _ --- -- - Capacity +S�_Q__ --_ Type �yC""Material_--� No. Compartments -'g......... Distance to nearest: Wel! /p 1 .Foundation Prop' Line LEACHING LINE No. of Lines -------�_--.-------- Length of each line--------,[DO`_ _""-- Total Length .Q? a__1_••-•- - Type Filter Material ��__RbPA'.-Depth Filter Material Distance to nearest: Well ---00 XX_------ Foundation ----- �-----•-------- Property Line ---•--• f t 1��,�- - SEEPAGE PIT— [ ] Depth -------------------- Diameter ---------------- F. Number ------------------------"--- Rock Filled Yes [INo i❑\' 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) I 1 cK FI"crL Q---------'---------- ---�X_t"5�7fv- :----- ------------------------------------------------------------------------------------•-----------------------=-------- -------------•----------- --------------------------------------- ----- (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 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 permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .......�-- - 7r-1 o e! o"(Y. Owner BY --------------- ----------------------------------------- Title -------- -------------------------- (If of er t an ow -.................................... FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y--".-� 0 _" DATEqBUILDING PERMIT ISSUED U--7 - ADDITIONAL COMMENTS ----------- -DATE ----------------------- - -• - [on by-- -------- ------------------------------------------------------------------------------ ----------------------- ---------------------------------------------------------- Final Ins pection by; .-_"--"-..--------------------------------------------------------------------- -- ------- ------------.-Date --- ----- ----- �- SAN JOAQUIN LOCAL HEALTH DIST.'.ICT E. H. 9 1-'68 Rev. 5M