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ti FOR OFFICE OSE APPLICATION FOR SANITATION PERMIT ...._.....__..../. j! ........ . .. ._ (Complete in Triplicate)�._ ..x _....... ...._w.__.Permit No. �~f ......................................................... ..........:...............................:....:........ This Pormit iExplys 1 Year From Date Issued 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. 549 and.existing Rules and Regulations: JOB ADDRESS/LOCATION .. . ._ CENSUS TRACT p Owner's Name .1&12ru ...... i t . .._..--•-----•-----•--•............. :....:................Rhone ...._._.:.. Address .....,.�• �-.....------•---•--� =----� ..•-............. .................:City ...........__:......-----.��__ Phon ----•-- ... ... e.... 4 Contractor's Name --------✓rJr y..�t� . ...... � ��.$� Installation will serve: Residence❑Apartment House 0 Commercial❑Trailer Court ❑ i Motel ❑Other........................ ................... -_ Number of living units:_-_. .... Number of bedrooms ..`........Garbage Grinder ...... Lot Size ---...--...-_---___-------------------• Water Supply::Public System and name ........ ....................................... .. .._.Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Ov Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan® Adobe C] 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 204 feet,} PACKAGE TREATMENT SEP[ 7 TIC TANK I Size..............••-•--....._..:-•_---------- Liquid Depth -•.................. t 'J Capacity''- •--------------•- Type ---- Material........ N Compartments Distance to nearest: Well .. ..... .....Foundation ... Prop. Line f LEACHING EINE [ j Na. of Lines ............_ . f.e Len th of each line............................ Total Length ............................ 'D' Box .---.------- Type Filter Material ....... ...... Filter Mat rial .................................._-_-_._ Distance to nearest: Well ...?:... ::.. ..... foundation --.................. .. Property Eine ................ ....... i SEEPAGE PIT ] Depth .................... Diameter,`�.. .. ....... Number ............ .. Rock Filled Yes ❑ No ] Water Table Depth -•.................. ...... Rock Size .-••--•--. .................. Distance to nearest: Well ----_.--- ........................foundation ....... ........... Prop. Line ....................... kEPAIR/ADDITION(Prev. Sanitation Permit*:..........._..---- _ Date .................. Septic Tank (Specify Requirements) -------•-'-. _............. .:,. ... ....... -••---- ........ ................ .. �. , .......................... .. Disposal Field (Specify Requirements) .. 'aNl�i .� :... .''.. .. --pl��'. vK---- - /gpD........ ......Z—_C.H :....'EXtp-X.41-.`:::...� P.! . €_. . .................. - = = --------------- Draw existing and required addition on reverse side) ! her byJef-H��hPlhave prep red this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and hulas and Regulations•of the San Joaquin Local Health.District. Herne owner or licen- sed agents signature certifies the fallowing: "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ------------- ------------------------- -----------------•-• .................. Owner BY ---------- -----------I ---- ---------------------•------ r- .-F_... Title ...--- ._... _..(If other.than owner.)_ F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _77-f-R-8--.... -:--- - -_F_FA_!9y2`......... --------------------------------- . DATE. a__:�A6------------- BUILDING PERMIT ISSUED ------------------------ - -----DATE .....----------•------------ ADDITIONAL COMMENTS ------------ --------------------- ----------- ................................................----------- •---------•............. ..._._ ------ - -------------- ___1_1------- . - -- -•-- ......_. _y ti r .......-----Y�1'� °'.. . . ........Y.l ........... ... ....... IFinal Inspection b ...... .......................................... •--- - -------------- --:---Date ..... - - ---....-------- EH 13 2h 1-68 Hev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M