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FOR OFFICE USE: ?PLICATION FOR SANITATION PER' _ . ._ ...... ............... . -- * .w 1./ Permit No.].Z.. ... . ..... ---...---. _------------------ - --- ---------- (Complete in Triplicate) .. Date Issued _-.-.---_--- This Permit Expires 1 Year From 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 _SPO-0----T-st- at------------------...----.__-------------... ...CENSUS TRACT ...1 1---------------- Owner's Name :MR. .��. -L--------In-pt-t-t-NT----- -------------------------------------.Phone .- .------ --------- Address yQ �ti N.QV - w - - - - City .: )- a�T ... 7Q< L F--------------- Contractor's Name --- 5. _ ---- ------ ------- ------ -----------------.License # - - ... --.. Phone ------------------------ Installation will serve: Residence g Apartment House❑ Commercial []Trailer Court ❑ Motel ❑Other ----- ---------------------- ------... Number of living units:_- -.--._. Number of bedrooms ...;�----..Garbage Grinder .U.�_. Lot Size . Water Supply: Public System and name __..w T ----MOUFx -r __Il1y--._11�f-_AVA-S--_.....Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ PeatJ6 Sandy Loam 0 Clay Loam C] Hardpan ❑ Adobe C] 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,) PACKAGE TREATMENT [ ] SEPTIC TANKX Size.- ------ Liquid Depth ___..._.-..-.-..._..-. Capacity(000. Type f*16.1_*S Materi;I:060t6fWSQNo. Compartments -.'2-------------- Distance to arLr est: Well .... .. ---------.----Foundation _u DJVq7._ Prop. Line I----------- ....... LEACHING LINE No. of Lines Length of each line._.3.0)__------------ Total Length .... Q,f............... 'D' Box ._._.__. Type Filter Material _?_ kkp 01h1Depth Filter Material -;_?.r.._---------------------------- ...... Distance to nearest: Well ------ ------------- Foundation ------__ --- Property Line -_.........-..-- SEEPAGE PIT [ ] Depth ._------.___,---- Diameter -- ------------- Number Rock Filled Yes ❑ No Q Water Table Depth ---------------------------------------Rock Size Distance to nearest: Well ..Foundation ------------ ------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----------.._-..-.-..---. ---.-.) - Septic Tank (Specify Requirements) ------- ----------C--------------------------- EILW isposal Field (Specify Requirements) ._-�..(.�...�'.------LF--I-� ---- E-V--u- -�--`'-`',-------- t3oV G R QQ-0-0- E �-- a- ---- ---- A ---- -o---�. „ ..$�. .......... - ------------------------ - - -------------- --- ----------- --------- ----------------- ---------- (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 ..r - 2-1�-V LLL. _ .C!! ✓ ----------- Owner By .....110 �_.. . .... ------....._ - -- --- - ---------- - -.- Title _.._.. ....- - -- _..... - ( otl'f" hey than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ... . _ ---/ e .__ ----------------- DATE _T _27_7 -- --------------- BUILDING PERMIT ISSUED -------------V...............------- ------ ------- ---- -- ------DATE ADDITIONAL COMMENTS -------- - -- ------------------------------------------....-----------....--- - - --------------- ------------- - --- - ---- --------- --------------- - --- -------------- ------ -- ----------- ------- ---- ---------------------------------------------------- -- ------------------------------- - --------- - --- --- - -- ----- - - - - - Final Inspection by: ------- -.-- --- -- -- - - Date SAN JOAQUIN LOCAL HEALTH DISTRICT . H. 9 1-'68 Rev. SM '��