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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ..............:... ... .--T-� 7 ;j Dafe Issued .`�......... C � . ...._.. .... ... ...... This Permit Expires 1 Year From Daft 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 Regulationsr +• JOB ADDRESS/L TION .JVUS .,•,yt-rL. .. '"v?"'�G ...CENSUS TRACT . .. sr�l Owner's Name OY`�L�-..p�' �r E y � �'ec' ..... .... �6 hone .��.�..��(..... Address i)3 L Gam. . �O/tirbt�cr_�'` -Q /f4'...�.�.�. . ............City /LGr�......... ................................... Contractor's Name oDli./r.�. _d�/� v!. . . ................License o`✓317-6 .- Phone a7�.�..'..4 ./-...! Installation will serve: Residence R Apartment House Cl Commercial ('Trailer Court C) Motel ❑Other _. .. ._. _ :....... i. Number of living units: . ... Number of bedrooms . ..........Garbage Grinder . ... Lot Size .��.X.�Sv-•••--••••-- Wate; Supply: Public System and name __......... . . ...............................Private fp, Character of soil to a depth of 3 feet: Sand C] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Q Hardpan E) Adobe Fill Material ._ . .. If yes,type. . ...._.. ... . . 1PIot plan showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverts side.) y- NEW INSTALLATIrN: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) J, PACKAGE TREATMENT [ ] SEPTIC TANK( ] Size...11i,00........ _. ._ Liquid Depth ... . ....................6 i Capacity Type g�2wc_ .. Material._._. .. Na. Compartments ••-- N r Distance to nearest: Well /OO./_„ .. __......_..Foundation. /o.f. ..._ Prop.Line..f f.'.......... ? - LEACHING LINE [ ] No. of Lines 3 Length of each line 4/0 r . .. Tota[ Length/.14.. N Q J' Box &0"'� Type Filter Material Ack.........Depth Filter MaterlaL24Y..r.-1` .... ..................... � , v Su�Pl Distance to nearest: Well ./DO. _ _... Foundation /D f- -- Property Line r.f ......... r ,{ tsEEPpc�PTfT [ ] Depth'yX //. . "D.eyrsre7er ..... Numbe• .7 ... ... .. Pock Filled Yes No Q Water Table Depth _ __. ._ . . Rock Size ... . r� Distance to nearest: Wet /00 . ..............Foundation /Of. Prop. line .J-t ........- p I REPAIR/ADDITION(Prev. Sanitation Permit/gK`_.. .. .. -... . .. Date .................... Septic Tank (Specify Requirements) /f4'�� +J ,,,,` . _L_. .. .. ...-. ._... P Disposal Field (Specify requirements) ..✓ -..... Q. " '�� - --- .. .. - "- >•' _ ._. .__........ ..._._.... _. _.__. . .. _.. ............. ....... - (Draw existing and required addition on reverse side) ,-s'x- _ I hereby certify that I have prepared this application and that the work will be done in eccerdana-with San Joaquin County Ordinances, Slot& Laws, and Rules and Regulations of the Son Joaquin local Health District. Nome owner or Ikert- ted agents signature certifies the followi;:g: j "I certify that In the performance of the Werk for which this permit is Issued, I shall net ompley any;psrs n 101 manner os to become object to Work m�n's,C�empenwNen laws of Califemia." " SgnedZE.c�-�-- r✓ - .C�4CL4-lti .......__._.. Owner By litle (If other than owner) /J FO"EPARTMENT,USE ONLY APPLICATION ACCEPTED BY vW'o - DATE y .?/ 76.. . .• BUILDING PERMIT ISSUED _ - DATE - - •• ADDITIONAL COM!/,,s ENTS 0,er/ e�yo.cnJ�o H...�¢rY.e -love a /Oo'f/irj/ i�iJ�-Oft/ '- '• W.,4/f` .e/ 1Av7� dfrlG G41.f4 �ful/f/Cfil /1M� -. Final inspection fA/.c{^7L.�.r,t' �'i- O yle;e Tl. .-. ' Final inspection by: . l/Il�ry _. . _..... ...... ... _.. _Cate . .... . ... SAN JOAQUIN LOCAL HEALTH DISTRICT 13 24 7/723M E. H. 1-'b8 Rev. 5M -