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FC,;,pFFICE USE: APPLICATION FOR SANITATION PERMIT �•¢•=,----- ..."-•-- (Complete in Triplicate) �c�ig'r/lWo Permit No.. 1 "%`%� ._.-. ------- ........ This Permit Expires 1 Year From Date lsst ed7Zw �4 Date Issued .%/i" /� L 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 C u �Lfty Ordi ante No: 549 and existing Rules and Regulations: ` IO773 JPl�Iv.4a g JOB ADDRESS/LOCATION ._19ja.P1✓_ch OJI l `, � f' - -- � " p �1Y1"ISN-CENSUS TRACT ._..•.---•-• Owner's Nome _ ---•-•-------- ..: e -Al. n.z.,�------ --------------------------------- --------�y..........Phone ............---- ------...... Address --.. ��.%,�-Jam.-----.5.-- _ ..... �- ---------------- city Contractor's Name ..-.+ ./-rte. . f '� License 3� Phone ..�/2. Installation will serve: Residence ❑ Apartment Housed Commercial ❑Trailer Court ;❑ Motel ❑ Other . -------- Number of living units:. .... Number of bedrooms ... Water Supply: Public System and name ........ _-_ _.-Garbage Grinder Lot Size ................................. ----------- ._.__._-•_._ ...... ....... .----------- --- ------------ ---_ . -------Private ❑ Character of soil to a depth of 3 feet: Sand Silt ❑ Clay [] Peat ❑ Sandy Loam •❑ Clay Loam Hardpan ❑ Adobe CI Fill Material - --- If yes, 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 seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT (] SEPTIC TANK.( ] Size -.------- 8 -_---- Liquid Depth .yA-- \ Capacity �_�-ddT e --0/ _- ..+... 2 Q Type �$Vo. Compartments Distance to nearest: Well -------- �4 v -_------__----,Foundation /.p-_- --. --- Prop. Line ...SS " Length o eah line ...._�/ " LEACHING LINE [ ] No. of Lines ......... gcne .._..-. -_ Total Length ...-_..f..�..- 'D' Box ------- "" Type Filter Material ......_-_Depth Filter Material r Distance to nearest: Wel! _---_� Foundation _.%. CJ-� -" Property Line. SEEPAGE PIT [) Depth --- ..- Diameter--- ------ Numbe- . ------ - ....__...- _ Rock Filled Yes F-1No0 Water Table Depth -- -------- --------------------------------- Rock Size ..... - -------•------- Distance to nearest: Well --- .................__--------".-----•Foundation - __-_- Prop. Line -------"._-_---- REPAIR/ADDITION (Prev. Sanitation Permit 4# "------------------- ---------- ------ Date ................•_•__• } Septic Tank (Specify Requirements) ....... Disposal Field (Specify Requirements) -_.-_-"-------------- •---------•--•................ --- ---_ ......... ........ ..-------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued I shall not employ as to become subject to Workma 's Compensation laws of California." P y any Person in such manner Signed - _ .......... -------- Owner i�p By Title - (if other than owner) -"- ------- � 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __. _.". - .-..Q BUILDING PERMIT ISSUED ..y-. ... - • ------ DATE 9- ..................... ADA TIONA COyM5VS _. i/.�fQ.�� .... ..-tie��_bAc9a,agi.o - •------ ---- -- --.... ---.o....--"--....-------- - ✓ - Final Inspection bY' 1. .-•------•--•-----•--------•--••----••-------•---•---•--•-•-•------------•-----•-----•- -..... ..�.... �............ Date _ SAN .. JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ��