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FOR FFICE USE: APPLICATION FOR SANITATION PERMIT Permit No ( �` -1033 �o ......... ... . ....:. ................. .. ........ . . .7�......._.. !Complete in Triplicate) ............................ _. y This Permit Expires f Year From Date IssuedDate 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: / Q[� JOB ADDRESS/LOCATION ---------.1., �...G�.PRld.... 2-r— .._42T.0CKM.N....CENSUS TRACT .......................... Owner's Name .. �. 4ao b"-g....---..................•------.._.....----------------.................Phone ..9...-4�-_.e.;�Q. .. F�r'dJ - ---------- Cit _.o-?qq�-.T.©-±`-�-------------------- .. ............ Address . _ .. �-----------------�---.........---............ ..-�------------. .. . .. y ......../.---- /--- • Contractor's Name .-0.�. -ti H.P—e-IS ©nLS...._X.t4.�__.....License # ........ ............... Phone ...q .7 . 07 Installation will serve: Residence [KApartment House 0 Commercial ❑Trailer Court ❑ Motel 0 Other - - -------- ------------------------- Number of living units:.. . ..... Number of bedroo i 1.____ arbagejGGnder ....... Lot Size _.df®---- --_. .................. Water Supply: Public System and name ..... ............ CLLR -. ---�,__. •-- .---_-.------------Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ CI y ❑ Peat❑ Sandy Loam ❑ Clay Loom 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 [ I SEPTIC TANK j I Size................................................ Liquid Depth ----.---_-..__..........� Capacityk Type -------------------- Material.----..-.. .. ....--- No. Compartments ._.................... Distance to nearest. Well . ---------------------- ---Foundation ... .................. Prop. Line .-...--r.__..-_...--- LEACHING LINE No. of Lines Length of each line ... ..... . ........ .... Total Length -----------. 'D' Box ..... Type Filter Material --------------------Depth Filter Material ...........................,---.. -_--_-- Distance to nearest: Well ......... ......... .... Foundation .............. Property Line ........................ �. SEEPAGE PIT [ ) Depth Diameter ................ Number . .... . .... Rock Filled Yes ❑ No 0 Water Table Depth --------- .............. •--------•..._....Rock Size .........---........._. ........ Distance to nearest: Well .-•-------------------------------------Foundation -......... . .-..... Prop. Line .._.... .......... REPAIR/ADDITION(Prev. Sanitation Permit# .------- -.- _._................. Date ....._...._._.._ ....... Septic Tank (Specify Requirements) .. 'f,.YuST.1 kA,G------ ------------------------------------------------------------ ------ ------ Disposal Field (Specify Requir ents) ....1_. _1CkA -I-------"� ---.i. . _ �'r`'. ._ ..-J�.. .................. ............... - -- ---. ..... .......................... ....... (Draw existing andguired addition on everse 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, Nome 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 Workman's Compensation laws of California." Signed . . ... u�A_22-I-W-.7#--�®-Als -------- By . .. Q.. f. .. Title (if other t n owner) FOR DEPARTMENT USE QKLY APPLICATION ACCEPTED BY DATE -.//-Ia-7y. ..................... BUILDING PERMIT ISSUED . DATE . ADDITIONAL COMMENTS .. ...------• . .. ............ .... .. --.. --. ..--.... .................. .... 4RICT - ... ..........:0. Inspection by- ---- ----------------- .----- Date ..��'� ..... ....-- .----------..:.... SAN JOAQUIN LOCAL HEALTH jpl � E. H. 13 24 1-'68 Rev. 5M 7/72 3 M