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FOR OFFICE USE: FOR OFFICE USt:: APPLICATION FOR SANITATION PERMIT l............... ........... (Complete in Triplicate) Permit No.... -----_.J ----- d-:---------------- o? Date Issued __ ./.. _"_-•-7-71 ...................... ...................... This Permit Expires I Year From 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB RESS/LOCATION_.....Bg3 .L�/ S� h`/�d�'£ ._ F.....---- --...-- •- -----CENSUS TRACT-------- ------------- -------- Owner's Name -- --�t1cS� S-- LUE G ------------------ Phone...-?._.3/—Ol' -�-�--- --- -- ...t9/ `...:. ``.�...:�C.. ....... ....--...-- -- :...: ,_. --- ------- �.-�---------- ------------ - Address----:- -- -----F'.�.38../�1G{_r£�iUl Li¢.t/L City S7Gl ter/ Zip ��Sa/.c •...- ----------------- ------------- Contractor's Name---- P.. nlsf :- -- oil/5._.. 3�3 Phone L .License #_A�S.--- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ ;{i T Motel'❑ Other,.: ........ --- Number of living units:-....�._.._:__-Numl3er of bedrooms.,-3._... Garbage Grinder---._-...---Lot Size.__... �_.. x. z p__f._,- . r Water Supply: Public System and 'name_.................. ..-------- - ------------------------Private Character of soil to a depth of 3 feet: Sand ❑ /Silt ❑ Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe Fill Material- . ,..If yes, type................................ . [Plot plan, showing size of lot, location"of system in relation to wells, bu(dings, etc. must be placed on reverse side.} NEW INSTALLATION: (No septic tank or seepagem pit~permitted if public sewer is available within 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size` .... ------------------------------------Liquid Depth.---- .------------ -p- L�K/577�(/1y Capacity--- -- 'aYp P `1 ---�---- --.T e.- ---------<........Mate.Tial-------------- --•-•------No. Compartments. . Distance to nearest: Well------------- -- - Foundation....... .Prop. Line.......---.........-. -...7:t I LEACHING LINE [ ] No. of Lines ----------------------------Length of each ling--- ........ Total Length .... ..................._............ 67)(/S A4v 'D.' Box...:........Type Filter Material_ Depth Filter Material.`::................................... ----_--...-.--:--� Distance to nearest: Well--------------------/__jqFoundation.--------------------.......Property Line--------------...-.............. ..� SEEPAGE PIT `tom ` [ ] Depth.- -...- Diameter--------------------N�er_....-----•--.------------_-..__ Rock Filled Yes ❑ No ` ,EX/57"1�fr Water Table Depth------------------------ ----------- Rock Size....--,.- Distance to nearest: Well...........................................Foundation.........._......- _ 'Pro-'P.Pro'p. Line..-..-------........_ -.. �- x193 Date �,o (g } REPAIR/ADDITION (Prev. Sanitation Permit#...................... ... Septic Tank (Specify Requirements[ -._±.........--=: _-------------------------- Disposal Field (Specify Requirements)..E!UST L 8•��Xo?:S=-Sf,1�4A6E-p/_TX--yS L ..,...._-•-..----------------------'------------.- ,:,.---`------------------- - - ----------- .---....---------_.._...-.--------.............. . --- --- -----........... ............... - W _(Draw existing and required oddition-on reverse side) I hereby certify that I have prepared this application',and ihat the worst 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 licensed agents signature certifies the following: j A 4^ "I certify that in the performance of the work for which this.,permit is issued, I shall:'mot employ any person in such manner as to become subject to Workman's Compensation laws of California." A Signed------ -- -----`.--- ---i ` -- ---. -----° - . --Owner. f $ By--------- - --------------------------------------- ---...:.... Title � P�:TIC{. = F� (if other than owner) F R d ARTM N_ SUS NLY - APPLICATION ACCEPTED BY............ . .. . t /' .7g . ------------------------- DATE ..- �` --- DIVISION OF LAND NUMBER.-._-i r. .�� - / - :- _'-_.='_ .:1_-•: >_:.. _.---,., _:..: ,-r- _ D'ATE...-- . < - - ADDITIONAL COMMENTS- - ----- ---- - --- ti- . -- - --- -------------- ------ ------- . .� ---------- -------- ` ---- --- -- -•. ---------- --- -- ------------ :::__ ------------ -..... .. ----- -- -� -- -- ----- ------- - ... .... Final Inspection by:. - ---------------------------------------"Date.-. - ........... ..... - -- ----------------- ------ EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT rss 2167-,REv..7/74AM