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A : , FOR OFFICE USE: ` APPLICATION FOR SANITATION PERMIT ' e4='�,.1'-�__, Permit No. !f_f y7 41 (Complete in Triplicate) _ = i Date Issued -- This Permit Expires 1 Year From Date Issued SQ _ Application is hereby madeto the San Joaquin Local Health District for a permit to construct and s ail the work herein described. This applicationI s made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA I fi � e� SO. �� f' u de" CENSUS TRACT r Owner's Name _A17570- _ } / -'��-�----- �"° S__ . , --------------------------------- ------Phone --------------------- Address __ 3 Gia fc�_ ---------------------------------- " �"? City --- - Contractor's Name __ � �/ � --- PLcJ- �---7;v f------"License Phone Installation will serve: I Residence gApartment House^❑ Commercial:[:]Trailer Court ❑. Motel ❑Other --------------------------- ---------------- �-..Garbage Grinder _- - Lot Size -7 S-- ---/ ---------- -------------- ------ Number of living units: ____ Number of bedrooms _-__ _ IIS. t L.._ 4r// 1---------- -----------' Private ❑ Water Supply: Public System and name _ c-jl_ __________ _____ Character of soil to a depth;II'of 3 feet. Sand'❑ Silt❑_ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe V Fill Material ------------ If yes, type ---------------------------- ol (Plot plan, showing size of lot, location of system iA 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) �1 PACKAGE: TREATMENT [ ] : SEPTIC TANK[ ] Size------------------------------------------------------------------------------------------ Liquid Depth -------------------------- Capacity -------------------- --- Capacity ------------ ---- Type -------------------- Material------- ------------ No. Compartments ---:------•--- _Foundation ---------------------- Pro Dis�tance to nearest: Well ___________________________________ p• Line ----_-------_------ LEACHING LINE [ ] Nof! of Lines ------------------------ Length of each line___-________------_-.------- Total Length _____--____-- _. -__ -. D Box ----`------ Type Filter Material --------------------Depth Filter Material ---------------------------------------=•- } Distance to nearest: Well ________________________ Foundation ------------------------ Property Line _____._._______-__._.:__ i SEEPAGE PIT [ ] Depth Diameter _______________ Number ---------------------------- Rock Filled Yes '❑ No .i❑ Writer Table Depth ------------------------------------------------Rock Size -------------------------------- 1. I Distance to nearest: Well ----------------------------------------Foundation ----------------• -- Prop. Line -------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ---------------------------------- Septic --------------------------------Septic Tank (Specify Requirements) ------------------ - ----------------------------------------------------------------------------------------- --------------------- e Disposal Feld (Specify Requirem nts) -----�� ---/I2q! ----� f'- '' 'r ;. _4117I p LL - ------ ____________ __ _ -------------------------------- (Draw existing and required addition on reverse side)Il ' I hereby certify that I havl�e 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 perfo4nance of the work for which this permit is issued, I shall not employ any person in such manner as to become subiect to Werkman's Compensation laws of California." Signed � t�- '�- spa--- :---._' Owner fl t-------!�" ----- - ---------- Title ---------------------- (If other thark owner) J6 FOR DEPARTMENT USE ONLY uEE� i DATE APPLICATION ACCEPTED BY ______-- ----------- ---------------- BUILDING PERMIT ISSUED'S,I------ - -DATE ------ � --- F ---_- � ----------- ADDITIONAL ADDITIONAL COMMENTSIA -------� , -- ------------------------------------ ----------- ` ------------------------------------ -------------------------- ----------------------------------------- 1(----------------------- --------------------------------------- ----------------------------------------------------- ----------- - ` II _ _ __ - Final Inspection by. 11 Date --- -- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 �- 1-'68 Rev. 5M,,