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a- •FQR� FFICE USE:---------------------------- A-491. ` ,� APJPLICATION FOI "SANITATION, PERMIT ---------=---------------------------------------------- _ ,C(� (Complete in Triplicate) d } '�`� �ermvit..-A _C1_(_7-�!_�- ------- ------ This Permit Expires 1 Year From bate Issued Date Issued __ ----------- leo � Application is hereby made to the'San Joaquin Local Health District for a permit to construct and install a work herein described-.This.application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: l ('777,S- JOB f JOB ADDRESSLOCATION .._ w .o I `` I'th ` cS ----------CENSUS TRACT --- ' Owner's N e ._---I iDl Q f�1 G�I NIC#' f- Phone Address ----f�,Q 0r------139--- 39'-- - - --- - � ---- - -------------- City p -------------- Contractor's Contractor's Name ---E:Cr.. _- _�O©-�_e_ ---- C4 _4�+1L'V1 License # -------- ----- Phone -f-3 1 TSC. ,.1 Installation will serve: Residence 0 Apartment House- ] Commercial:®Trailer'Court ;0 "V-1 —•3041 Motel [:]Other --------------------- SCLOJO Number of living units_____________ Number of bedrooms -----------.Garbage Grinder __ _________ Lot Size ----------- --------------------------- I Wafter Supply: Public System and name _______________ ---------------------- Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay4 0 Peat 0 Sandy Loam •0 Clay Loam :0 Hardpan 0 Adobe 0 Fill Material -.________-_ If es, ..3 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 lank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT *'T"'SEPTIC TANK'[ ] Size-_____ __ t • - ------- -------- Liquid Depth -------------------------- Capacity /. � _ql_ Type -------------------- Material---------------------- No. Com artments stance t , onearest: Well ------------------------------------ Foundation ---------------------- Prop. Line ------------------•--- LEACHING LINE [ ] No, of Lin'I es -------------------------- -= -------- ==---------Length of each line--------- ine--------- ---------------- Total Length -------- ------- - - ------_-- D' Box -_-_:______ Type Filter Material ____________________Depth Filter Material Distance to )nearest: Well _______________________ Foundation ------------------------ Property Line SEEPAGE PIT _ Diameter Number ------------------------.--- Rock Filled Yes 1 No C] ---------------- Depth Water Table Depth ------------------------------------------------ . Rack Size ------------------ Distance to nearest: Well ___-____________________ Foundation -------- ------ Prop. Line -------•------- REPAIRfADDITION(Prev. Sanitation Permit# -------------------------------------------- ' Date - ---------------- -- ----} Septic Tank (Specify Requirements) _____________________ Disposal Field {Specify Requirements} _Dt �_- j xt�,�,Act 0 r .] ----------------------------------------------------------- {Draw existing and required addition on reverse side) fir sP 6 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and`Rules and Regulations of the San Joaquin Local Health District. borne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------- - ---- - BY --- r� --(If er than owner --- -------- --------- --------- ---------- ----- Owner Title G�A_lae 1 FOR DEPA1tTMENT USE ONLY APPLICATION ACCEPTED BY ----- DATE ___-_ _- -- -cT__- BUILDING PERMIT ISSUED D DDITIONAL COMME TS _.Ct_ �_ � eu. � W�_ t DATE- ---------------- ------ - .._. � £.�..-----_Cid te=.� _.C.,o------��-----��+�.e l_�`v�°"-----��ca�_i_ _ ---#*v-- - ------------------ ----- 1 - ------W---- - -----nZ �4 a- --------------------------------------------------- -- - - -------------------=--------------------------------------------------------- - Final Inspection b ------------=---------------------- Date --- --------------- - Y -------- - ------ ------ --------------.Date � SAN JOAQUIN LOCAL HEALTH DISTRICT } E. H. 9 1-'68 Rev. 5M