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FOR OFFICE USE: APPLICATION FOR SANITATION P ..............• ...... ....,.:..... �. Acom,plete.la Yriplisatal PERMIT . Permit No. .. --65. This Permit Expires 1 Year Dane Issued .................... ....................... from Deft � � Application is hereby mode''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 No. ADDRE „ .. 9 N'. Golden S5/LOCAT�ON Gate ...........................-...CEPiS11 S TRACT ........................... Owner's Name 1Hi'-S__Mil1.er... ......::.. .........................................•-----�..::.�,,::.:=-=•=...Phone . Address " -_-5i9.-N;- Gold-en�•Gate t kt ...............................Ci --••- Con#rector's Name icer •.............. - - ----- ......... . ...L se 271539 x-65 ......_. Phone . - . 2b16 Installation will server . Residence,[ Apartment House Commercial . ..�, . -- _ fl railer Court II Motel Q Other..•-- - :... Number of living units:--1.1_: Number of bedrooms .__ - 3__....,Garbc qe,,Gr ander Lot Size --------------------------------- Water c r e Water Supply: Public System:and name' --O alit_. -----p ar c e ---. .._ tom``_,s .....-......._:_.-----..__.... .........-•.......................Private Q Character of soil to a depth of 3 feet: SandC). Silt y C3 clay Q Peat❑ I Sandy loam Q Clay Loam Q i, Hardpan p Adobe U drill Material R.Q......if yes, (Plot plan, showing size of lot, location of system In relation 'to wells, buildings, etc. must be placed on reverse silo.) r NEWINSTAtlA1IONi (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) I REATMENT ' PACKAGE T. [ ] I+SEPTIC TANK f ] l!� Size.......... ...................... Liquid Depth ........................... Capacity ---------` ........ Type ..... ....... . 'Material._: .... No. Compartments :................... � Distance to nearest: Well ....................:...Foundation . LEACHING LIN Prop. ane .................... L E [ ] No. Lines ......... ...... .. Length of each llne...._(..- I 1+ Tota Length 'D' Box -- .... Type Filter Material ......... - ; ( h-Filt ......_... s Dept Filter Material ..----•-- .... • ............. Distance to nearest: Well ..............':_...... Foundation • ........................ Property Line ........................P SEEPAGET [ ) Depth ...................... Diameter Number . Rock Filled Yes Q No Q i Water Table Depthfl' -•........................_....---••-•--. ......Rock Size ................................... ro Distance to nearest: Well .........................................Foundation _ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit Date • ............ -- --. ._ :... _....-.... .......__... Add 401 .._... Septic Tank (Specify Requirements) . leach 1 irie and .1 sump ..... ........................... to exiting Disposal field (Specify Requirements), ----Ze_sc1�._�'i,e,�,d-�...............::.. .......................................... .......•-•.................. •-----•-•-------,- ---------II ---------•------------------ ................. . --- ...._.......... .........._... t Draw existing and required addition on reverse side} . - ------------------- --- I hereby certify that I have prepared this application and that the work will be done In accordance with San JoaqvM County Ordinances, State Lawii, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or licen- sed agents signature certifies th following. "! certify that in the performance of the work for which this'perm.it is issued, 1 shall not employ any person In such manner as to become subject to Workman's Cornpensation laws of California.", Signed ------- A-1.tA�P.= _--1 - Owner - -----=•-- _------ By ........... -----=--------- title Contraotor-__.. other an owner) fOR DEPARTMENT USE .ONLX i t APPLICA N ACCEPTED BY ._'I DATE ._ . ..=.�..:2 5�..:_._. BUILDING PERMIT ISSUED ------�''-----•--------- •- - - .................... ---------------------------------------------------- ------ --------------------DATE _...-----.- ....................... ADDITIONAL COMMENTS ---• -------- ---------- .---...--------------.-____-__-..------------ f................_..._...__.-------------- .................. .... _ __.. -------------------- - ___-_ a _ �.._.__.._.... .. ______________________________ ..-.._.----------................................... Final Inspection b ....... ................. ..------.-,..:-------•- •--•- ! I p y: .. --- Date ,� ------ ................................. SAN JOAQUIN-LOCAL HEALTH DISTRICT, 8/7h. 3M e