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NO N ES - A(.a4 M E Dd) FOR OFFICE USE, i� 5-.7-7-5- APPLICATION '.7-7S APPLICATION FOR SANITATION PERMIT .. .................................... Permit No. 71..-��. .�L. (CCoosik Nto fn Triplicate) > Date lasued .................... ......................................................... 17 This Permit Expires 1 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. 849 and existing Rules and Regulations JOB ADDRESS/LOCATION.5,.,,.#&. JO Ck y. ......................... .. .....A.�v./.�L.' ..��..��! .......V..�Z...�b..Z..L.�,r... .. CENSUS TRACT Owner's Name ...../.��t. ........,�.�.. !t�S ........... . .... .. .. ..............Phone .................................... Address .... 0�OCa .ArA-55.t?l.Y.......44(.............................. City ....7YA.�,- ................................................... Contractor's Name ...!6 .4ev..Tl`O..�K....f....5.42.4 ............:........License #l`� 'S f G... Phone��''?3,`.� •'2!'',�� Installation will serves Residence M Apartment House❑ Commercial []Trailer Court 0 Motel ❑Other ............................................ Number of living units..../ Number of bedrooms .� Garbage Grinder Lot Size ��'.. /.. o ....... .. ........ ............ ............................................ Water Supplys Public System and name ....; ... . ... ....... ...... ....... ...Private ❑ Character of roll to a depth of.S feet, Sand Silt❑ Clay ❑ Peat Q Sandy Loam fl Clay Loam ❑ Hardpan❑ Adobe$4 Fill Material ............ If yew,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 see ge pit permitted if public sewer is available within 200 fast,) PACKAGE TREATMENT ( � SEPTIC TANK�' Size....` .. . ::%..`.X..�1................. liquid Depth .....`1...:.............. Capacity .I.9.0V. Type 8:G..CysxMaterial.. oto! .. No. Compartments .....4.......... Distance to nearest, Well �........................... .......Foundation L e'........... Prop. line ..R.-5....... LEACHING LINE (/�No. of lines f!.......��..: length of each IUe.�. !� ?. Total length ' :: . ... 'D' Box ....I...... Type Filter Material At24.1k......Depth Filter Material .. d.elf.............. ..... Distance to nearest, Well ........................ Foundation ...p....:............ Property Line ...rs................ SEEPAGE PIT ( ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No C3 WaterTable Depth ................................................Rock Size ....................... ........ Distance to nearest, Well .............. .....................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation'Permit* ............................................ Date ..................................) SepticTank (Specify Requirements) ..........................................................................................................a.............._.............. t Disposal Field (Specify Requirements) ..................................................................................................................................... ............................................................................................................_............................................................................................ (Draw existing and required addition on reverse side) R 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. Hem* owner or Ilcon- sed agents signature certifies the followings "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 become subject to Workman's Compensation laws of California." Signed .......4... T �.s'!!. ..... .....`�.�s2.!5!.............................. Owner `� ` By ....... .................................... Title ........................................................................ o er)�� FOR DEPARTMENT USE ONLY ............... DATE ... `.7 ........... APPLICATION ACCEPTED BY.... 'i.t3. . ...................................:..................... BUILDING PERMIT ISSUED ........ .... ..DATE ... ...... ADDITIONAL COMMENTS...........1.... �lT.... . ..R...L X .....1 .C M.� ...AI*4).N I- .......4AS ...... . : l!r z,E3 :�--.: : :. : , �... . .:��'' �5 ..:.............. ........ .. .iR .;�......................................... Final Inspect a .. . ..�.............................................Date .......................... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241•'68 Rev. 5M 7/72 3 M