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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .................................................I...._.: Permit No. ....7� .....'C' 5 (Complete In Triplicate) �- --------- ------------------------------------ . L ;... This Permit Expires 1 Year From Date issued 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 a existing Rules and Regulationse OiDj '2 JOS ADDRESS/LOCATION ..-. .. .._._AVA r. r . . - . ._... CENSUS TRACT Owner's Name e?M�..... rv�x�g ,w.................................,......--•--•. -- •--......- ----... - •----.........._ ...Phone w _ Address ................................._._.._._...-----....:-----------•---- --- --........ ........... City 10� ._. ...�...- •.... Contractor's Name A-/�-`--C_.�,�c�.-•.,_.:_._ _ _.::'-- � - 8' - Q -meq' ----�---=-_--License-# r1- D-G!- Phone Installation will serve: Residence❑Apartment House Commercial❑Trailer Court 0 Motel ❑Other -------------------------------------------- AA Number of living units:............ Number of bedrooms ----------.-Garbage Grinder ............ Lot Size-Aep. ,------ Water Supply: Public System and name Private Character of soil to a depth of 3 feet: Sandi* Silt❑ Clay ❑ Peat❑ Sandy loam fl Clay loam ❑ Hardpan❑ Adobe❑ Fill Material ............. If yes,type ............... ............ 1 (Plot plan, showingp 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 sewerjs seweravailable within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK f ).GKI �!/ liquid. Depth .............. Capacity ---------------__ Type .-.._.....••--.--.-- MaterialZ/tr&4r._...._ Na. Compartments 49. Distance to nearest: Well ----------------- ..Foundation ..._--.... ......__--.Prop. Line ---T �.'.. u' LfiAQW - Total Length :........................... • ------------------------ Length of each line_......-------- =----..-- � D' .-.......... ter Material ....................Depth Filter Material _.......................................... is ante to nearest: Well ........................ Foundation ........................ 'Property line ......... ............. • � I SEEPAGE PIT [ Depth --------------- Diameter ................ Number ---------___..........- Rock Filled Yes ❑ No iCi Water Table:Depth ------------------------------------------------Rock Size --------_..................... Distance to nearest: Well ........................................Foundation -------------------- Prop. Line ....................... R ADDITION(Prev. Sanitation Permit# __ Date ) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ------------------------------------------------------------ l --------------------------------------------------------------------------------------------------------- ..............-......,.....—.................................. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State taws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner. as to became subject to Workman's Compensation laws of California." - Signed I - Owner -. . $Y ---------------------------------------- ---- Title .0 ------• .. (I other than owner) F2F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----. DATE ------ BUILDING PERMIT ISSUED ------------ --------------------- -- ----DATE ....----------------------- ............. ADDITIONAL COMMENTS ------------- --- -- ...............-------- ----------------------------------------------------------- ----- ---...---•------------ ..._._ Final ins ection b Date .1 �,` ---_._. p y. .. --------------------------------- ------ EH 13 2!t 1-68 v. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M