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FOR OF�i'CE U5t: APPLICATION FOR SANITATION PERMIT . Permit No: _ _Y//dam (Complete in Triplicate) This Permit Expires 1 Year From bate Issued Date Issued _A�-'._____-____. --------------------------------------------------------- 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 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---� .9g---- ---L�IVI-Ol�i----------------- /-�.L .Ad----CENSUS TRACT ....... ---------•--------... � .--Phone Name __ _-__ TlLR!T�H_ ,, ---------- ------------------------------- - Address -------2917-3q x -,753 - 4-E—M-0 ? 'U City - Cg LOI ---------------------- Contractor's Name -- �7.WNE1 K--------------------i -------------------------License # ------------------------ Phone '-A_0CJV',1-_--._--•-- Installation will serve: Residence Apartment House❑ Commercial :❑Trailer Court ;❑ } t') MotelOther ------------ ----------------------------- I 3 .-'Garbage Number of living units:.___ _------ Number of-bedrooms __ ____-Garbo a Grinder -_____._.___ Lot Size _____ =CPE( ! 1 ______________ Water Supply: Public System and name ------------kI--------------- ------------------------------------------------------------------------- `---Private,0� ; Character of soil to a depth of 3 feet. Sand'❑;= Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam : Hardpan © Adobe '❑ Fill Material _Y49__ If yes, type ---------"------ ._--___:_ (Plot plan, showing size of lot, location of sy t m in relation to wells, buildings,, etc. must be placed, on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sew`er-ris available within 200 feet,} -' / PACKAGE TREATMENT [ ] SEPTIC TANK,[, r Size-3-ZA9---_X---�--._______ Liquid Depth ____. __!_-�- -.- 1t Capacity -©�- ------.Type P-AC-_��_.1�z_ Material_41A�--------- No. Compartments ------.-----•-•. ---. Distance to .nearest: Well --------------------------Foundation ..../V------------ Prop. Line =--- -- .---------- LEACHING LINE 1 No. of Lines -------/-------------- Length of -riot a ch line------5 ------_------ Total Length r, ----------- D' Box ' riaf � aDepth Filter Material --- ------- e 17__ ... ;__ ___________�-,_-.--_--- ...est:.-w ------ Property Liney' ------------ Distance to nearest: Well ____,-__�_�__________ Foundation _.____1�-__ p rty „___---------------•-•_-- SEEPAGE PIT [ ] Depth ----------- -------- Diameter ______________ Number ----------- Rock Filled F s ❑ No i❑ r Water Table Depth --------------'-----------f---------------------Rock'Size -------------------------------- Distance to nearest;Well ------ ---------/------.--------------Foundation --------------- .... Prop. Line -------------------•- REPAIR/ADDITION(Prev. Sanitation Permit# -------------- ------------------------------- Date ----------------------------------I Septic Tank ]Specify Requirements) - ------t-------------- ------------ -------------------------------------------- Disposal ----•------------------- --------- ;. u Disposal Field (Specify Requirements) -C_ ST �l1/�yTl_ 1 --,--J ----FpR-----A� Tt�_�'_SQC_J__1M"I------------------------- t L DD-1.7 7a/,/,---49NL. 3 ;= ----------------------------------------- -`' ------ -------- - _ --------- - -. 1= {Draw existing and required addition on reverse side) 1 hereby:certify that (..have prepared thisaapplication arid-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. Homeibwner or licen- sed agents signature certifies the following: i "I certif in the performance f the work for which this permit is issued, I shall not employ any person-in such manner as to eZ� e subject t or a s Co`m ensati.on laws of California." .. Signed _.__ Owner �. - --- -- --- = - , BY ... -- - l '�'• _^_ Title -------- -------------- ------------------------ -- ------------ ------- ------- {If other than owner) '— -` FOR-DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY R-r- -------------------------------------- ------------------------------------ DATE ` -------- BUILDING PERMIT ISSUED -------------------- --------------------------------------------------------- ---------------------DATE ----------------------- -------------------- ADDITIONALCOMMENTS ------zi--------------------------------------------------------------------------- ---------------------------------------------------- ------------------ ------ ------------------- ----------------------------------------------------- ------ ------------------- _ - = - ---------------- ------ ------------------------------------- - ---- -- --- -- ---- - - ----------- • -- ------ - -- -- ---- '--- ---- ------- ------------ -- --------1- ------------------ ---- _ _ _ �°.x".; �-��1 ..i.r� sir --- _ Final Inspec" b = _Date SAN JOAQUIN LOCAL HEALTH DISTRICT p < E. H. 9 1-'68 Rev. 5M