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FOR OFFICE USE: APPLICA` QN AOR SANITATION PERMIT �� r - ---------- �. Ohl' - '� .. Permit No. az-`/, --------- (Complete in Triplicate) ,I Date Issued This Permit Expires 1 Year From Date Issued i ------------------------- ------------------------------ i 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: -11.1 d JOB ADDRESS/LOCATION -- `�� _-._/ � f� � --------------------------- ----CENSUS TRACT -------------------------- Owner's Name .-.-�. �'ff, S /a% Q t 051-------------- Phone � 5 Address ---6/6A =--- ----------- --------------I-------------------------------------------- --. City - ©f ---------------------------------------- ------- Contractor's Name 1- .-- 1 �U1G License # Phone Installation will serve. Residence:p�Apartment House❑ Commercial :❑Trailer Court ❑ I Motel F-1Other -------------------------------------------- Number of living units.--- ------- Number of bedrooms -,,;;2------Garbage Grinder /.�_ ---- Lot Size _ �---------- -- _____Private �. i Water Supply: Public System and:.name------------------------------------------------------------------------•--,-•---------------------------- ❑ Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay E] Peat E] Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ____________________________ (Pl'ot 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 feetj PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity -------- ----- Type -------------------- Material--------------- - - No. Compartments ------ -•-------- QC 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 ----_-----------------------------------•--- Distance to nearest: Well ________________________ Foundation ----.___---------._____ Property Line -----------_.___-_-:._-- SEEPAGE PIT �[ ] .`. Depth _�------------------ Diameter ---------------- Number -___.-_ -------------------- Rock Filled Yes ❑ No 0Water Table Depth --------- -----------------------------•------ Rock Size Distance-to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -----.-------------- - REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------------------.--------------) I Septic Tank (Specify Requirements) --------/f e99?.C/G'fi'-------OLf �l�i 1 �1` .-�G��' --•----------- Disposal Field (Specify Requirements) __ � ------ �'r��` iQ ( r� � 1 �--f --;�' �S/7/Il __________- ------------------------- -------------------- - ------------------------------------------------------------------------------------------------------- -------------------------=--------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have preoared .this application and that the work will .be done-in accordance with San Joaquin County Ordinances, State Lows,�and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen. j sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I1shall not employ any person. in such manner as to become sv ject to Workman' Co pensati.on laws of California." Signed --- --- 40tthae - ----- ---- --------------------------------------------- Owner r Title BY - ------------------------- -------------------- ------- (Iowner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYV------- DATE -- -- '---- -7I--•--------------••--- BUILDING PERMIT ISSUED ------ }------ ------------------------------------------- --------------DATE ---- -------- ----------------------------- ---------------------- ADDITIONAL COMMENTS .-_�L _ 2-34-7-it------•-- y� � -------------------------------------------------------------------------------- ItdM/� ---------- ---------------------------------------- i ------ ------------------------ ------------------ ! = --------------Date { f- ----------•------- - Fina! Inspection by: __�-�- �9xV-C_'_p------------------------------------------------------------------- --- - 3 �l SAN JOAQUIN LOCAL HEALTH DISTRICT k E. H. 9 1-'68 Rev. 5M.