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FOR OFFICE USE: APPLICATION' FOR 3 FOR SANITATION PERM Permit No. . PI P S'/.. . (Complete in Triplicate) { •_ 1 - - - Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made o / Pp bdtthe Sa n Joaquin Local Health District for a permit to construct and install the work herein A described. This application is made m compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . .... .... . J CENSUS TRACT ........ ... ...... ..._ S STA�v,<49 Owner's Name ....�r -.... 'f c��......--------- .... ne ..�.`(3�N..�,5-/•-•1� Address � ...-...r!.... Sra. _ ..... cry License .. Phone ,} Contractor's Name ...b!.�i:L'.(��..;. ... _.. - ...................... - - _ _ Installation will serve: ResidencegApartment House 0 Commercial QTroiler Court ❑ 7k Motel Q Other_.-....------- --------- Number of living units:.... ..... Number of bedrooms ,,3-.....Garbage Grinder ----- Lot Size ...357Aelf4fC....-.---- Water Supply: Public System and name ......................... ...... ........Private jR Character of soil to a depth of 3 feet;! Sand j] Silt Q Clay Q Peat❑. Sandy Loom Q Clay Loam Q i Hardpan ❑ Adobe W 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.) PNEW INSTAILLATION: ACKAGE TREATMENT ( Jo septic SEt nk or seepage pit permitted if public sewer is available within 200 feet,j lR t ( TANKS J Size (No .:....... .--------- Liquid Depth P ..... ................ d O .. . . . Capacity � `TYIe -...-... . ': Material.-C. L .4. C No. Compartments -_2.................. I neorestr Well O..Cf Y .- .->C'h.........Foundation ..ld ------- Prop. Line _-. ---•• i s ............... Length of each line..-7.--- ...--.. ......--. Total length .l�Z......._.....----.... DDist$oxe. to .... . LINE No. of Line, � �-c/� -LEACHING� I j 1/--- Type Filter Material ..Ta x-_.Depth Filter Material ....-16f.-.-......... .----. J Sc"�"� Distancjlo neorest: Well I!!n'.rA. ��y. Foundation �1.-.. _...........:.. Property Line ................ ` �_ [ j Depth (<!- ... . . Diameter`7. .g...... Number ..........1:....... ..... k Filled Yes J No [) i Rock Size ----Water Table Depth ............... ........_------- -'eqC-Dis ance to... -arest: Well --DUpr_«-e,--.......Foundation _..4� ... Prop. Line ..cJ.. REPAIR/ADDITION(Prev. Sanitation Permit t6s .....----.................................. Date ............ ........ .. .-.Septic Tank (.Specify ui _. .:.-.-.- ....... . ................._........f...."...-... Disposal Field (Spetify Requirements) - • . ... . . . .. .... .......... _ ...... . ..... :.......--.--------- _ . ........ .....................: . . .. . . .- � r..... I` (Draw existinc -- required addition on reverse side) z[ I,hireby certify that I have prepared this application and that the work will be done`in accordance with San Joaquin i County Ordinances, StateLaws, and, nd Rules and Regulations of the San Joaquin lot 1 Health District. Home owner or liven sed agents signature certifies the followings "1 certify that in the performance of the work for which this permit is s}'iiue3;Iia n omplaY any Mrson in such manner astobecome subject o War man's Compensation laws of California.," Signed ._ .i - ..................-------- Owner $y . aide . ....... (If other than owner►:....... r , ONLY ^ t= _ APPLICATION ACCEPTED BY ...__. I r FOR DEPARTMENT USE O- DATE 7 - .. 77 _ .. _DATE•.:-:.r................ .... . BUJtDING-•P.ER�M4T..ISSUED-....... . ...:... ....... ------�---- -.. .,... ....-.. . D <... .COMMENTS .......--.-- -----------_.....:...................------'--------.--......---:..............-...........:....................,............._...-. ADDITIONAL COMME ............. 7..... .. ..... .. �f .... .. Final Inspection b ...... .... •-.. ..Date / P Y ... x -- SAN JOAQUIN LOCAL HEALTH DISTRICT t 7/72 3.K