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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r . a �'hermit {J tComp#ete in Triplicate ..... This Permit Expires 1 Year From Oat*Issued Date ...77 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 '...��.9.. aC&#�&e7.................................... ......................CENSUS TRACT .......................... Owner's Name .....................4.c�f}....F4.fw:!f.T-A 1..tA...............................................Phone Address . . ...... ... .. ..�..__..n�'-�9-t?'1.e....._...... .._.._ .y..-.�' City ... .ATL#I .o-p................. . ..............._.------- Contractor's Name t.��.l�1.r.P. _R C 1'-5-:.44_11L.. C._cf ...License 9P ........................ Phone ...; Installation will serve: Residence gApertment House Commercial [3Traller Court ❑ Z 3- Z-,/qt 7 Motel ❑Other ............................................ 6 Number of living units:.....4..... Number of bedrooms .a......Garbage Grinder ............ Lot Size .... .- ©............. Water Supply: Public System and name ...................................................................................................Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam Oe- Clay loam ❑ Hardpan ❑ Adobe 0 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 I ] $ize................................................ Liquid Depth ..........................,0 Capacity ............ Type -------------------- Material...................... No. Compartments ......................-0 Distance to nearest: Well ........foundation ...................... Prop. Line ...................... LEACHING LINE [ ] No. of Lines ..._....- _------- Length of each line............................ Total length .......................... D' Box Type Filter Material ....................Depth .Filter Material .........................I................. . Distance to nearest; Well --- ._.......... Foundation .............:.......... Property Line ........................ SEEPAGE PIT { ] Depth -- ------ Diameter ................ Number ...................... Rock Filled Yes ❑ No Water Table Depth ........:........ ::....Rack Size Distance to nearest: Well ........................................Foundation .................... .Prop. Line ...................... f REPAIR/ADDITION(Pr®v. Sanitation Permit# ......_._______________.:_.:...._............ Date ..._..............................I ` F Septic Tank (Specify Requirements) ---:_....: � - -- ----- ......................... Dispos I Fiel (S ecify Requirements . ..._._ ~... ... �� ' --�:........ R .. a-�,e�.: t 6.1 .r'..... ----- (Draw existing and required addition on reverse si ' I hereby certify that 1 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. Hone* owner or licew sed agents signature certifies the following: "I certify that in the erformance of the work for w ch this permit Is issued, I shalt not employ any person in such manner as to bece subjecta Warkma 's Comp sation I ws f California." l�X Signed i BY --•-------------- o-t-h--er th-r th an-------ownn --er] (if o ------------..;-'` f !... -. 3itle -- - 4 -----......-..__-----.-_-----..--._.- t/ t ' R DEPAR MENT USE ONLY APPLICATION ACCEPTED BY _.. DATE .��.�.- -- - -----.- . ......... ----- --- ----- - BUILDING PERMIT ISSUED ....... ........... ... DATI:"-::_..:.:- ...................... _. ADDITIONALCOMMENTS -------------------------...................................................- ................. 4 rr............................................ ......... •-_•___•_• --------- -- --•--.......................-........... •-----'--._._...... 11 _-_• �_-. _ ...... FinalInspection by: --------- . •.-•... ............ ...•-----.._....--•- ------------- ----•-- •-----.Date .. 7..---.. EH 13 24 1-68 5M SAN JOAQU LOCAL HEALTH DISTRICT 8/7h 3M