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�1FOR OFFICE USE: f f t APPLICATION.FOR SANITATION PERMIT - fa ------- (Complete in Ttiplicate) Permit No. ro_•/_--_- /y - -------- I This Permit Expires 1 Year From Date Issued Dat sued Application is hereby made to the 5an Joaquin Local Health District fora permit to construct and install the o k herein t described. This ppplication•.is madb in compliance with County Ordinance No. 549 and existing Rules and Regulations: ^ .JOB ADDRESS//LOCATION -__S_ AQ.cSI LI. � I `k'; t ° � `� ��°�""`' -_--CENSUS TRACT _____ Owner's Name ._�b: ]1�1 ;aD }1� ---------- r t f --------- ��jj Address -----4-1-1----- '�"1~I e/a�. ---------------------- ------- - -------------- -� -------- ---------Phone Vb 9-8, --- Contractor's Name �(._ _ 1� - 4 r _-.License #,-�5 .3 Phone Installation will sferve: R sidence� ApartmentCommercial: House❑ Commercial❑Trailer Court ❑ t � Motel❑Other --� _ 19, r Number of living units:------� Number of bedrooms }_______Garbage Grinder tXJ ' t Q Lot Size' Water Supply: Public System and name 1___ ,,__ yy �c,., #k 9 i ��-' lN --- Q,Vf_Cl� I Private ❑ 1 - ----------------- ------------------ --- Character of soil to a depth of 3 feet: Sand 1] I Silt.E] Cla " . t »,� ❑ Y ❑ Peat EJ Lobm ❑ Clay-Loam:❑ .�, type Hard T - . . p ... Adobe Fill Material P _ .., -..� If yes, [Plot plan, showing size of lot, 1 ation of system in relation to~wells, Ijuildings;„.etc: must be,,placed; on reverse side.) NEW INSTALLATION:. [No septictankor seepage pit permitted if public sewer is available within 200 feet,} --PAS �UTREATMENT [ ] SEPTIC TAMC' ` tr t t [ l;- !- Size ---- -----_ Ca Liquid Depth --- --: Capacity p Y - --- ---- --- -•-- Type -------------------- Material--------- ---.---- --- No. Compartments ! -- ----- D,stance to nearest: Wel! ""CEACHINGLINE�'- r1_.._..N ......` 'ne�._ L i - 0. r_ r oP• No. �_:� ..� pr Line ------------------------ ength o ea ine ----- ---- ---------- FTotal Length"w I .----------------- D' Box - "- ----- T !� t.r - - "' : . Type Filter Material.__ Depth 'Fitter ,Material -__ _ Distance to nearest: Well ___________ _________ Foundation ----------------- ----- Property Line. SEEPAGE PIT [ ) Depth -- ---�-- - ---------------••--••- p --------- Diameter ---------------- Number --_-------------------- - Rock FilledYes C1 No .i❑ { Water Table) Depth ---------------------------------------------..--Rock Size -- --------------------- Distance to nearest: Well ---------- Foundati -- I ------------------------------ on ----------_ ------ Prop. Line -------------�•----- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------------------ -------- Date - ---------------- } Septic Tank (Specify Requirements) -------------------------------- �A� �-------- �� fsposal Field [Specify Requirements) __4V ~-_, � - ll! "1 J, 1' .E : t 4A It-dNOi.E 1 11 L >j N-----— lh1 $ 11'tUC'� --------- (Draw existing and required addition on reverse side) __ I hereby certify that I 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. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which thi3Apermit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----- -------- - - --- ---- - - - --------------------------- ----- - - - -- Owner {� BYE-1: 1. #3 (If other--than owner} 1 -- ------ - -- ------ Title _.___ hldeE-t2� -------------------------------------------------- FOR .DEPARTMENT USE ON1Y, APPLICATION ACCEPTED BY --------------------------- BUILDING PERMIT ISSUED ' DATE ------ ADDITIONAL ------ ----------- ----- ---- ---- -----------=------------- -------- ---------------- - ADDITfONAL COMMENTS ----------- -- - - �_------- q _` - 'l` r _DATE - - -- -------- ------- ------- -------- ----- -- --- --- --------------- ------------------- ----------------------------------------------------------------------------- ina Inspection by: ____ __ _t- ,L&J__ -------------------------------------------------------------------------------------------------------- =------- - ----------= ----•---------------------- ----------------Date ----- • SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M