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FOR OFFICE USE: APPLICATION FOR SANITATION: PERMIT -------------------------- IpiI 6- {Complete in Triplicate) °^ Permit No. _-_.�___�_Q__--_-- i� Date Issued ---1_1-------------- ---------- _1_______________-----_,__ This Permit Expires 1 Year From Datelssued - Application lis hereby made to the San Joaquin Local Health District for a permlit to construct and install the work herein described, This application is made in compliance with County Ordinance L�o'�49 and existing Rules and Regulations. JOB ADDREIISS/LOCATION __._l U_ C9(o__--- .�. _ G Qrr_- C�-TC/9 - CENSUS TRACT ----- r'-`:, Owner's Name ------- , .------------------------------------------------------------------ --Phone ------------------------------------ Address --- 1 ---- /� ' ----- -- City '�a'rP�`' Contractor's)�Name ---------- --- ---------.---------------------------•--- Lieen FM # J Phone I �a !e -C�� rI Installation will serve: Residence Apartment House ❑ Commerciale❑Trailer Court i❑ - Motel ❑Other _--- '`� I / ` g de --------------- --- - ------- ---r ---r------ Lot Size �� psjr 19� Number of livingunits:---- _----- _ Number of bedrooms --�_____Garba e Grinde� Water Supply. Public System and name---------------- ------------- - -------------------------------------`---------------------------Private [� ,p Character of soil to a depth of 3 feet: Sand' &It fl Clay-❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ____._I_.--__ If yes, type _.______________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings,�etc. must be placed on reverse side.] ip IM i V , NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available wpthin206 feet,) 0 PACKAGE TREATMENT [ ] SEPTIC TAMC:[i41-' Size------------------------1-------------- ------- Liquid Depth ----------------------••-_ Capacity �49_P_--------- TypeQ/V-_4r'A---- Materialco-lyGrj{e_ll No. Compartments Z............... Distance to nearest: Well __ ��---- ------------------Foutiidation _ �______ Prop. Line ___x"-.___________ :. hs L lEAEH�P�FF1�3E [�No. of Lines ----- ------ -{Length of each-line---- ___ Total ;Length1.10 X� Box -,- Type Filter N4ateri - pt { __L_117jp -------------------------------- 'D' { o1 - lr�e__Deh Filter Materia! Distance to nearest: We!! 'rrSD ell __�' . _._________ Property Line __s _____________-_-___ SEEPAGE PIT [ ] Depth _________________ ___ Diameter ---------------- N.umbo,�:._}------ -.-- .. -------- Rock_Filled Yes ❑ No f❑ Water Table Depth --------------------------------- � Rock.Size-~i----------------------------' Distance to nearest: Well ___ ____ - - ______________Foundation -------------------- Prop. Line -_------------------- REPAIR/AD ITION _-____--______-___-_REPAIR/ADDITION(Prev. Sanitation Permit# -------------------- - --- --------- --''Date------1---------------------- ------ , r Se tic Ta 1 :F Septic nk {Specify Requirements] ---------�--------- - ------------------=----=--------------�-,i:::_T:_-�-��-,-•--- ----------------------- ...... ----• ------ €I i - -. i Disposal ;Field (Specify Requirements] :---------- 11- f f a -------------------------------------------- -------+--,---------`--------------- ------------------------t ------------------------------ *-- ` ----------- I� (Draw existing and required addition on reverse side) I hereby certify that I have prepared'this aPPI ketiort-and-that the work will be done in accordance with San Joaquin County Ordinances, State Laws,-and'rRules and' Regulations of-the-Son-Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 5r c i - ----�--] "1 certify that in the performance of the work for which this permit is issued, Ii shall`not employ any person in such manner ,l. as to beco subject to Wo {cman' ensation laws of California." Signed: _. . .lam __— T�------- !=. ---------- Owner 1 _t ry By ------- ----------------------------------------------------------------------------------------------- Title ---------------,_ ------------------------------------------------------- {]f other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- •Q ---------------------------------€!-------------------. DATE _ I ~J ---------- BUILDING PERMIT ISSUED ------------------------- -------------------------------- -----------------------�]---------------------DATE ---------------------------------•--------- ADDITIONALCOMMENTS ---------------------- -----------------------------•-----------•-•------------------€k---------------------------- -- ---- ------------------------------------ i ------------------iM----------==----------------------------- = - --------------- -----`M-------------------- -------------------------------------------------------------- ----------------------------------------------------------------k-----------------_..----------------------------------------------------- 4 €p €[----------------- l Final Inspection by: �. ------------------- -- ----- ---------- Date r -./._ � - --- ----- - -------------------------------- - JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 ,1-'68 Rev. 5M