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}. FOR.OFFICE USE: P APPLICATION FOR SANITATION PERMIT ------- ------------I----------------------- Permit Permit No: -----7y7 `- -� (Complete in Triplicate) ----- ------------------------------- Date Issued -- -_�_�_ Z ' _-__-_---------- -------- ------------------------ I This Permit.Expires 1 Year From Date Issued Application is hereby made to the PSon Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with CountyOrdinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION .--.3!P3-7-- ----_.---V-- -----t f�- ---------f�-D-.---------------CENSUS TRACT _J- -7-------. _ Owner's Name ------------ �D• AI-�------- -- �1�F�-� �----------------------------------- `--------------------Phone ---------------------------•-------- -- ©-3- b -------S--- L"�--------d�D�------------------- cit ��C_��„Q_nl---------------------------------------- i Address. �__ _ 7 - - Y ---- Contractor's Name -------- 0-111.[/V_ER------------------------------------------ ----------.License # ------------------------ Phone ---------------•---•---------- Installation will serve: Residence XApartment House❑ Commercial ;❑Trailer Court ',❑ r , Motel ❑ Other ------------- ------------------------------ , �.•.. Number,of living units: -_-I----- Number of bedrooms ______Garbage Grinder Lot Size ,-----C- --___-_.-- Water Supply: Public Sys#em and name --------------------------------------J1--------------------------------------------------------------- f Private; Character of soil to a depth of 3 feet: Sand Silt❑ r`CIayT[]� Peat,Q Sandy Loam ❑ �; Loam❑ ;`. Adobe Hardpan;❑ % ' ❑ Fill Material _ -- 6__ If yes,type ---- ''-----;-------------- O (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. mus#F be placed on reverse side.) W_. NEW INSTALLATION: (No septic tank or seeps pit permitted if public sewer is available within 200 feet,) °Q PACKAGE TREATMENT f ] SEPTIC TANK Size____ _``X_f a__ ____ 1 '-- --. Liquid Depth ___J� _____________-_--__ _. Ca ocit / _�_______� T el" `Materialm rF No. Com artments Y Yp ` ( p , istancewto—nearest: Well-_ r�---___ `_. u dat�on�-l- _:' ___--Prop. Line:_ __ '____ '21—LEACHING LINE No. of Lines ---- -_______ Length of each line--___� �7-�------------- Total Length ------/ Q____.. Type !I ri 'D' Box __ __ yp� Filter Material _�Q C�DeptFi`-F,ilter Material --�-�_____^-_..3�______r�l�b Distance to nearest�_Wefll _ •_ _77! Foundation .. Property Line SEEPAGE PIT [ Depth ------.___--------- - LDiameter `=---- ---: - Number ---------------------------- Rbck-Filled YeswED' 'No ❑ Water T_ble4'De t ---------------=- =----- ----=---•----Rock Size -.- '.. a" -------------------------- ! e Distance to nearest:•-Well ____-----`-:_.:_------------------------Foundation _______ _._.____.__ Prop. Line 1____._.__-__-_____ REPAIR/ADDITION(Prev. Sanitation-Permit# _--`•------------------------------------- Date ---------------------------------- Septic! ------------------------------- -Septic;Tank (Specify-Req 'ementsl ------------------- --------11----- ---------- Disposal Field {Specify Requirements) --------------------------------------------------------------------- ------------------ --=--- f----------- g f----- - M - ---t---------- I --- -------- - ---- -`-F -----_ -_ ----------' -- --------- _- { . 'i. _�I -r '••''' --- - '-----' -- - --- +r ------- '- ----- --- - -' - - 1 - T I I r!' i --. __ - - - +_--- T Y i prepared pp erse side) i J t c (Draw existing and required addition on red 1 � I herebycertif thut'l have re ared this application and that the work will-Ise-done in accordance4ith!San�Joaquin County Ordinances,fStbte-Laws, and Rules and Regulations of the Son Joaquin Local+Health District. Home owner o'r licen- sed ager is signature certifies the following: ° 1 "I certify in the!perfor ace of the work for which this permit is issued, I shall }o.1 employ any person in'such manner ' as to b o e ub' c't to W an's-C pensation laws of California." ( I I k - I' Signed ._ e c Owner€ � ' E i ' i . BY }-� -- � ---- -------,-----�4R--Q------- Title ---1------------------------------ I (If other than owned{` ` FOR DEPARTMENT LISE ONLY APPLICATION ACCEPTED BY � _____________________ ___ _ DATE 7 �------- ? f - f r BUILDING_I?E@MIT-ISSUED - --- ------------ ----------- DAT1= � ADDITIONALCOMMENTS -- ----- ------------------ ------ ---- --- ------------------------------{ -----_--------------------------------- ------- --------------------------- T ---------------------------------------- ------- -- ----- _ -------- --------------- �-- - �------ � � _.. --ter ___ ` Final Inspection -- --- - ---- --.Dae ---- I SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M. G