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,eAZ APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. :. ........... ........ This Permit Expires It Year From Date Issued Hate Issued . ............... Application is hereby made to theSan 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: r JOB ADDRESS/LOC T ONl'..... Z5.. Gl �Xf•�--...-,- 'Fb��AwID..... �f.3�1�'C�...........................CIrNSUS TRACT ............_... Owner's Name ..._ �( •• •-••-�• ----------------•--------.-• --•••••..........._.... _ Address .__ .��-�-------- ....Phone .�3. -.. ... ... .__ 'i7.-..... 1_Sri` ..........--------•.................. .... City 1KA.xxr , /� 1 y� Phone . •- • 1 '? Contractor's Name � 44JA J ........................---.... ...---••----------• License # ............... 1.3� .. . Installation will serve: Residence Apartment Housed Commercial oTraller Court LJ Motel []Other....................... .... ............. Number of living units:..._'. Number of bedrooms I :._.._Garbage Grinder Lai Slze Z 4� • � .. Water Supply: Public System and name ...................... :.Private Character of soil to a depth of 3 feet: SandIN Silt Clay ❑ Peat Q Sandy Loom fl Clay loam Q Hardpan (] Adobe❑ Fill Material ............Ifes Y ,type....--.......... ............ {plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit .permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK /� � ........... Liquid. Depth ....... ©o Size... 0.... .. Capacity ' � .................. Type ----•----••• ..... Material.................. No. Compartments .0 ��'Distance. to nearest- Wel( / � ..Foundation d ....-- Prop. Line ,��........... ` LEAtH"ING LINE [ of Line's ------ O 0� Length of each Itne.._..��_ . . ........ Total Length .... I d. Box :; �r ..........•........ _ Depth Filter Material /q• �/ -.. ...... Type Filter Material !- �e . Distance to nearest. We-1i'T --•---••�• Foundation Property Line ... SEEPAGE PIT [ ) Depth ...--.f------------- D i_bmeter�s._.._......... Number ..-------- Rock Filled Yes [3 No ip Wbter;Table Depth y Rock Size Dittance-to nearest:Well . .,Foundation Pro tine .................: REPAIRADDITION(Prev. Sanitation Perna!# .............;:n ate .._ _ Septic Tank (Specify Requirements) . •--•-�.....: rte' .................................................. Disposal Field (Specify Requirements) . .. —_. P q ----- - • ------------------•- ................=........e^------------------------:.........._.:............. •-••----•---....-•-..............._... . (Draw exising.ond.required addition on reverse side) I hereby certify that i have prepared this ;P111cation andlthat-the work will be done in accordance with San JoaquinCounty Ordinances, State Laws, and Rulesd Regulations of �e San Joaquin Local Health:District. Hattie owner or licen- sed agents signature certifies the following: —� "I certify that in the perform. ce ofwthe rk.wof6rrE�is�errnit issued, shall noLempioy:anperson in. such manner as to bete beet o W man's,Corripettsaiion laws of California." `Signe ..__e , - Owner ------•------------ ------------------------ By ff ...... .. ......................... . ... ... - Title _..._....-.--• --------- -------------- (E other than owner} .•------------•--- FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY __1i1//� DATE _...2'�3:-7..-.- .---•••--•• •............. . .. BUILDING PERMIT ISSUED .....--.- :............. ............. . ........................................ ......................DATE ............ ADDITIONAL COMMENTS -----........;._...........---••- f .,..----..........-.... ......---••---••-•----•-•• ---------------------------........... ....... ..................._._._.SAN ------------------- Final Inspection b � --------•-•---------- ---------------------------- - ------ER --- • ----•---• --- - - -•'e =-�- -•-• ....._..Date ��l�� . . 3 2h 1-68 Rev. 5M JOAQUIN CAL HEALTH DISTRICT 8/74 314