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OFFICE USE: APPLICATION FOR SANITATION PERMIT __�4............ ... .IOL.'. (o /_ (Complete in Triplicate) Permit No. fFdl If .. .... ....... 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/LOCATI J _ 4_.VI-.--:fes- �'!-c.!1..- ---- ------ CENSUS TRACT ----- - --•-----...... -- - . �--�� add 51.x. Owner's Name - - - -. .. . --------------------3 .Phone -- -- - Address --- - --....�.. -�----Q�' dd - -------............__...`... City _.... - - -�{- - ---...M.. Contractor's?�lame ..--.--1 - -- -= =."'�...y_.. �.1-------,- ----._License#/004 /..... Phone :/..64'716."J .. Installation will serve: Residence❑Apartme`nttiou�se❑�..Commercial❑T� railer Court j] Mote( ❑Other Number of living units:............ Number of bedrooms ............Garbage Grinder ------------ Lot Size --- ----.. . • Water Supply: Public System and name ..........---------------------------�----...----...-- - ------------ - ._....... ....Private ❑ Character of-soil to a depth of 3 feet: Sand C] Silt❑ Clay ❑ Peat❑ Sandy Loam C] Clay Loom C] j Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type..___---------------- - p g 4� f s 'P�g K--� ,p-» t' ithin 00f tJ reverse side.) (Plot ran;"showin size of lot, location, f system in relation, to wells, buildin s,7etc. must be j NEW INSTALLATION^ INo septic tan 6 sdepage pd permitted if public sewer is avmlable�roithin 200 feet,) PACKAGE TREATMENT [ ]' SEPTIC TANK I Si e..._....._ Jtiquld Depth ---tV-------------- Capacity 1. 1?aAr-Type-1. -----_ - Material _t g zZ�.-,.. No. Co-mpartments .-- --....... \ E e Distance to,nearest: Well, ---Foundation-._._0. ,......A. Prop. Line ..- LEACHING LINE [ ] No. of Lines ..._....�., .�� Length of each/yline.._._..`0d........./...Total Length 9 ,.��.c�0............. D=•Box--_ ._:_.. TyiJe;filter'1Material _R10__?___Depth Filt r/Material _.....16-------------------------------- r e � , Distance t ^neorest:rWell. _._ Q............ Foundation .1.<...0........._ Property Line? �i 3 �...........I—........ SEEPAGE PIT [ ] Depth ...' �. Dia et r .'_ . �r - _- - ❑ 13_..__-_ Number ...__ -/. ...._._.__'Rack Filled Yes No 1. Water Table Delth _ _._._..___1_................... . ..Rock Size -1 Gtr-��lY....... 1�— ., Distance to nearest:W_eel) ... ..... Foundation ..../Q...�..... Prop. Line .......:..:.._.....- � .................. REPAIR/ADDITION(Prev. S6nitatjon Permit# ............._../_.._..._____------ Date._...__._.....-_._; )i \ /1 Septic Tank (Specify Requirem6 s) _----------- ---- - --------------•'--------................. y ,Disposal Field (Specify Requirements) --- ------ - -------- '?----- *- l ------------------ - ._ -/......... '..- ---------------- -- -- ----- "' - - - ------------e-1 )---------.....:- ----\ � - - ... -- !-- - i 0 (Draw existing and required addition on reverse side) i I hereby certify that I have prepared this application and that the work will.be-doneJn_.accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health Distdct.'Home owner or Ilcen- sed agents signature certifies the following: "1 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 14!Q_ J'� i iBy ------_ -" - - -�e .CA......................-------------- Jitle .----��.1. ."...............-................. .... .----"-' (If o than owner). (/J ( FOR .DEPART NT USE ONLY APPLICATION ACCEPTED BY ..._......... . ...•,�.�^{A - -- -- ----------------------------------------. DATE ..IlJa�--- BUILDING PERMIT ISSUED .............. .... / _ _ T - ----- j.. ._._.......... .... �,. - .._ JDA E COMMENTS d-_r ._.__ z< cf. .. ..b - ---.S?_Y__ __TC.----1----------------- ADDITIONAL ................ . - - . . - � .. ............. - --------------- ---------------- -------------------------------- .......- ------ ...1............. .........::.---:------- --- ---------- -- ... . ...... - ............. ....... ............. . ............. Date .. • Final Inspection by: - "f. �� --- �_.—SAN-IOAQUIN_LOCAL-HEALTH,DISTRICT.. E. H. 9 1-'68 Rev. 5M