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FOR OcFICE USE: PPLICATION FOR SANITATION PER --- --------------- - _ - - -_ Permit No. 72.-3..z....' (Complete in Triplicate) - ----------- -- --------------------------------- This Permit Expires 1 Year From Date Issued Date Issued 'Z ----7 L ------------ -------------------------------------------- - 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: rr y� p D,,, p u JOB ADDRESS/LOCATION ..5PU._V..__/n........PooP_.Boys-----I�_I_Y Jl�....__CENSUS TRACT 9___._......._... Owner's Name .V.1LL)-A M.--------P.-_18A ow_......... _ ---- ------------------Phone ......................... ..... Address 1.oS..Nnua-----Drzlm-------------------------------------- -----.......... City ..1WM.o.NT1_ ------- -�;ftur=-------------- Contractor's Name -------------$h�l - ----- ------------------ ---.....License # ---_- ----------------- Phone-4jS: mj.-.3.1_b Installation will serve: Residence XApartment House❑ Commercial []Trailer Court I] Motel ❑Other--_----------------------- --------- Number of living units:--t.--.---- Number of bedrooms _,.)-.......Garbage Grinder -IVQ,_.. LotSize40_ALA-C5W-i}O-�� Water Supply: Public System and name ..... t�.fL,...l`�i2RssQ::.la.....54,93--7Q-15.e4Ax_Q----Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt{] Clay [} Peat[' Sandy Loam ❑ 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,) PACKAGE TREATMENT ( ] SEPTIC TANK Size................................................ Liquid Depth .......................... Capacity -�jp.r)-b__.._ ype .................._ Material_Aj6i.t.LA*No, Compartments ....?-............ P r Distance to nearest: Well .....-----------..................Foundation .......'S--- --------- Prop. Line.,s2.66.......__. LEACHING LINE K No. of Lines .___._;�............. Length of each line---50.r__............_.._ Total Length ._�P_6--t--- --------------- 'D' Box ----Ili - :....__ Type Filter Material 9 cR-.) sDepth Filter Material .....aZ__<__tP-ti....................... Distance to nearest: Well ------_------- -------- Foundation ...____.._........_._. Property Line ........................ SEEPAGE PIT [ ] Depth _._.__---- _-_- Diameter ................ Number ------------------------_- Rock Filled Yes 0 No Q Water Table Depth ------------------------------------------------Rock Size ................................ Distance to nearest: Well ........................................Foundation ------------.__.---- Prop. Line .... ........... It N(Prev. Sanitation Permit# :............_ ._._...__..._ Date ....____...._..._.....____....) -. Septic Tank (Specify Requirements) _k- . ------ -------------------------------- - ---------`-------------^------------------------•------------------------- Disposal Field (Specify RAgiWe_� ... #1 2 ---... r- TLic7 -----lb_ EVN1:cv.......F1, Q---i ULr. G-R.ouviO--------LIZv�.. -a------ 1 IE---------- ►un. °- -"- �" aQX - -------------------------------------......--......------.............. ---------I---------------------------------------------------------- (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 sulblect to Workman's Compensation laws of California." Signed WA, ..---. --------------------------------------------- Owner By-'L----CA%-kl..�__— - ------------------------ ------------ -------_......._- jitle ---- (If other than owner) FOR PEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY ..... __._ /........... ..... ........... DATE _��a �,7� BUILDING PERMIT ISSUED -- - --------- ------------ ------ ......... _------------ -------DATE ------ ------------- ADDITIONALCOMMENTS - ----... ............... ................................. .......... -------------_-__------ ..........- - --- -------------- ------------ ------------------------------------------------------------------------------._...------ ....................... .................. ---------------- --------------- --------- - ---- ---- ----- - -- ------------- y , ...... Final Inspection by: ------ - --------------------- - - -- Date SAN JOAQUIN LOCAL HEALTH DISTRICT fA,, E. H. 9 1-'68 Rev. 5M