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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �/ Permit No. 1..--!` �. Z4.--------- ��'c--- ------ - r -� (Complete in Triplicate) ! - Date lssued -�`-«r7- his Permit Expires 1 Year rom„Date Issued l Application is hereby made the San Joaquin Local Health District for a permit#osConstruc# and install the work herein described. This application is made in compliance with County Ordinance No. 549 and exiitmg Rules and Regulations: -----CENSUS TRACT -----°-/-------- ` s JOB ADDRESS/1-0CA71 N .- --- ---� 4 Phone ----- - -------•----------- I Owner's Namef - ---- ' ' g' �� rrG -lY- ----------------------------------•---- Address 1�*/ -2we/f�r.YA-------------------------- city j Contractor's Name License # -- Phone Installation will serve: Residence ❑ Apartment House❑ Commercial : railer Court 'f] motel-ff-©ther------------------------------ i r Number ofIIiving units:-" Numb r of bedrooms ------------Garbage Grinder -." ___ Lot Size --""----= �- k l ------------ - - ----- ------------ j Clay,Loam Private _ r � Water Supply: Public System and nam "__ Character of soil to a depth of 3 feet: Sancl'flt[] Clay .❑ Pea! ❑ ' Sql di esot mI❑ C y ❑ r - i l Hardpan ❑ Adobe ❑. Fill Maters Y YP [Plot plan, showing size of lot,1 locatij n'of'system,in relation to wells buildings, etc., mu t be placed on reverse side.) \ it ermined if public sewer is ava,lable,within 200 feet,) `� NEW INSTALLATION: (No septic tan or seepag p p P F Siz 4)X.-' - _' - -- - -- Liquid Depth ----- A-------- PACKAGE TREATMENT f ] SEPTIC TJANK [ j j; " �`r Material- G---- o! Compartments ---- -------- -- r\ Capacity -fes TYRei V ! -----t_Foundation' mo-'!---------- Prop. Line ---�f D" once to nearest: Well "" "rte---------- 4 No.-of- Lines �" . - - Length of each line."" 6.0 a Sofia! Length - f Q ---.-.-- LEACHING LINE'� [ 9 i �t i '-=Z 1` 1 I �/ I -f 'D; Box' .X'"l, Type Hiter Material--°—Depth i ter Material --- ---�J�C----------�---• d' ep }} r Distance to nearest: Well � 1-------- Faundd#ion .�� ?-- - -=- Property Line. --- =-------- SEEPAGE PITj Depth D'iameter ---------------- umber ----.-------------- Rock Filled Yes [I NO 1 WatedTable Depth --------------------------------------- ----Rock Size -_�------- --------------- l istance to nearest: Well --------------------------------- Foundation -----' __- Prop. Line ------------- !i -------- ------ Date ---- ------�-----Y-�----------) REPAIR/ADDITION(Prev. Sanitation,Permit# ------------- --- ?II---------------------— m . --------------------------- Septic Tank (Specify.Requireents _ _ ,) "." .-___-"" -"___---"--------- - ----------------------------------------- Disposal Field (Specify Require fs)• - ----------- ----------------- = IV ---- -- ----------- ---- ._- `- : -------------------------------- ------ ---------------------------------------I---------- 17 s -------- — ------------ - -�---------------------------- -- - ------------ ------------------------------ -------------------% (Draw existing and req ice�cl addition on reverse si�e) I hereby certify thatl .have .spared this application and that'the work will be done lin accordance with San Joaquin County Ordinances, Stag Las, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature�ce ifies the following- 1.1 l i "I certify that in the jpe�or�nm 't of the work for which Ehis permit } �s�"sued, I shall 'not employ any person in such manner as to become s bjecf�' rkma 's Compensation laws of CaI� ifornia. s ' Signed -r. er �`----' ----`� - -------- ---------- , ( I------ ----------- Title ----- if other than o- - ------- ---------------------- I BY ------ ----;--- ------�-- - caner) i FOR DEPARTMENT USE -ONLY ' � --- f APPLICATION ACCEPTED BY''--._. -.-_-4 :1 --------------- -------------- - - ---------- . DATE -.- BUILDING PERMIT ISSUED ---------------- - ------ f----- ----DATE ----------------------- ADDITIONALCOMMENTS ---------------------------------- -------------------------------------- ----- -� -- - ----- --- ----- - - ---------------------- ---------- -i -------------------------- --------------------- - 11 1 ------- ! I --------.--- -------------------------------------- ------- % _:_=_=::- l ----- ------------------------- ........ Final_Inspection-by- " y SAN JOAQUIN LOCAL HEALTH jDiSTRIC„T1 - -31 E. H. 9 1-'68 Rev. 5M G