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"P f0R OFFICE USE: - _ A ' 41 7� APPLICATION FOR -SANITATION PERMIT - -- + ------------------ --- ----- 005�" P� Permit No. / � if` (Complete in Triplicate) -- �.. _ .. --.__--�":_�.�_.7_l____-__-___ 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 complia ce wlth my Ordinance No. 549 nd existing Rules and Regulations: JOB ADDRESS/LOCATIO ------.-------CENSUS TRACT ----------------•--------- Owner s Name - ------f✓( `- --- -' ----------------- -------------------Phonec_gp. f_r!v_f1� 7 Address .. City S�_cfz1!__�-------------------- ----------------- Contractor's Name _.___:__ -- .�. � , _ --.License # 1_ Phone4(0(0 6,197.--_ -- -- Installation will serve: ResidenceApartment House'❑ Commercial'.❑Trailer Court 's0 I r Motel ❑ Other---------- t Number of living units------ Number of bedrooms '____�-------Garba eGrinderr-1Q Lot Size 9 S e 1- 1 Water Supply Public System and name!.----_ '- -- -� __--_----_------------------------private ❑ 1 t r Character of soil to a depth of 3 feet: Sand'❑ SiltID Cay; ], `,;Peet❑ Sandy:Loam ❑ Clay Loam ❑ Ha jdpan'❑ Adobe Fill Material ------------ If yes, type ---------------------- -- 1 � s -- t t,t ! t p {Plot plan, showing size of lo 1,01#n of system Pi ,relation•to-wells,-•buildings;•-etc. must be placed on reverse side.) NEW INSTALLATION: ' t (No septicttank,or seepage pit permitted if public sewer is available within 200 fest,) PACKAGE TREATMENT [ SEPTIC TANK �I,.] Size------------------------------------------------ Liquid Depth -- Ca acit _- -- ----- -- T e ,P� Y Ty ----- Material�oundation -- No. Compartments ---------------_----- Distance to nearest:TWeH ---------------------------- ------ Prop. Line ------•--- - •- 1 {I LEACHING LINE [ ] Nay%of tines -------------- ------- Length of each line---------------------------_ Total Length -----------•------------ l D ;Box ---t....P-- Type Filter Material _-_________________Depth Filter Material Distance to+nearesf: Well ------------------------ Foundation ------------------------ kroperty Line ------------..-_..._---- SEEPAGE PIT [ ] Depth Y-------------- Diameter --------------- Number ------------------------- _ hock Filled Yes ❑ No �] Water Table Depth 0 ..Rock Size -------------------------------- Distance-to -----------------•------ ----Distance-tonearest: Well --------------------------------------- Foundation -------------- .---- Prop. Line -------------- ADDI -•-•-- RRPA4R , / T10N(Prev.(Prey. Sanitation Permit# -------------------------------------------- Date ----- --•------------------�------) � t , Septic Tank (Specify Requirements) ------ ----------------------------------------------------------------- ' Disposal Field (Specify Requirements) ------��_ _--- -_ --- __ _ ---------- �—�,� -. .— _ ✓.,(Draw existing- -and.required-addition on reverse-s.ide.)��,,,r,,,� 1 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.Reguicstions of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: f "I certify that i the performance of the work for which this permit is issued, I shall not employ any person in such manner +� as to becom su ect to Wo man' Compen ron laws of California." Signed ------- - ---------------- -------- -- ........... Owner -- --- - ------- BY - �d1 GT1u Title .-- ---------------- o er than owner) FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY ---- ----------- ---- --- -- --- DATE -- -_°'"_,�---'�0 `7�_---_- ---------- --- ---------- - BUILDING PERMIT ISSUED ------------ ----- --------- ------- --------- - ----------- ---- DATE -------------------- -------- ADDITIONAL COMMENTS ------------- --------------------------------------------------------------------------------- --------------=------------------------------------------------------ ----------- ] -------- -----------a— �. } _ Final Inspection by f - - ----------------------------------------------------------- ----- ----- ----------------------------------------Date ( �' = 7/ - -- 5 N JOAQUIN LOCAL HEALTH DISTRICT E, H. 9 1-'68 Rev. 5M