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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . (Complete in Triplicate) Permit No......................____.................... ....... This Permit Expires 1 Year From Date Issued Date Issued I 0S--0-Pin Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made n,co acince with County Ordinance No. 549 and existing Rules and Regu}atlons: i o �Ss N"i'h �4 m jam ,t�t✓ 5c>�a r�FF JOB ADDRESS/LOCATION —et t Aa. :. 1 ... _N.....` -I- > 'i .......S i Dg.........CENSUS TRACT Owner's Name _. .R.lft...�'_.L 1-i-�_...__..-f ft&eyX s......... .....................................Phone ...`A.4,77A os. _,. Address . _ ..........5. J--- ------- ------1' cW_..`�'.....�--`.f .............. City ...I.........s,ar`r�L1tT ? .......:..:................: `a- � Contractor's Name ...__ AZT l_ f.t.:i?_..._._._S._ C License -.-2-67 Y..1. 73 Pho Installation will serve: Residence❑Apartment House 0 Commercial ❑Trailer Court 01 i- Motel ❑Other .... !�. .: '!"` Number of living units:.-tom-__ Number of bedrooms t _._Garbage Grinder _417. Lot Slze Water Supply: Public System and name ..................................... ........................... ........Private Character of soil to a depth of 3 feet: Sand E] _-Silt 0., Gay- ❑ Peat❑ y Loam 'I]. Clay Loam HardpdrQ Adobe 0 Fill Material ............ If yes,typo k (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 240 feet,) -. , 2 PACKAGE TREATMENT j ] SEPTIC TANK' Siae.-.• ---.?X.S ---•-2C---9.. ............. Liquid Depth . ....7 ........... f Capacity_1. r_s1^4_Type .................... Moterial..CaoR?t':•Aef-r2No. Compartments .........3s f f R Distance to nearest: Well ...................Foundation .....LP.'_._....... Prop. Line ......i..........:..7 !' LEACHING LINE No. of Lines ......---y_.__._.-..._- Length of each line..........`3-S?__'......... Total Length .......9.0.t...........p I 'D' Box ............ Type Filter Material 1.:. ...&Aepth Filter Material ........... ........................ i Distance to nearest: Well ...... .'__...... Foundation .........LO.......... Property Line .......S ............... SEEPAGE PIT J Depth ....?.-�- ------ Diameter .....: -- Number .---------I................ Rock Filled Yes ' No iQ Water Table Depth ...............�-.--- ---------...........Rock Size ..._2_`, ' Distance to nearest: Well -........L!�'Q.....................Foundation ...../..A!....._. Prop. Line ....IS REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. Septic Tank (Specify Requirements) DisposalField (Specify Requirements) -----------•--•-•-------------------------------------------------------------------•-------...._......•---•----•••..........•-•--{-- r - . i i ..--•--------- -------------------------------- --------------- ---------------------------- ........................................._......... _...... (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 Heolth:Dlslrict. Home owner or licen- sed agents signature certifies the following: ' "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 -----__e, %n_.. 1_ ._.__cSL- ----- _.____--•------------- --- - - . _ Owner By ---------------•� --•---r ------- -----. 3itie ----- -------------------------------------- (If other than owner) tAzoz gkDEPARTMENT USE ONLY # APPLICATION ACCEPTED BY _. ---- -- - --- --- LrJ_. DATE __� �_..----_-•-- ' BUILDING PERMIT ISSUED ... --- ................. - ----- _ ---DATE - ............................... ADDITIONAL COMMENTS --- ------ --- --------------------- - :.... _... { - ---------•---- ---•-- ---- - ------•- ---------- -- ------------ ------.-.............._.._.--.---•---._._.....---..._._._......-----•-•----------------------------- ------------------ - - ------ -•- - - ----- -- --- • - ----- -• - --- ------------------ -----•---------------- ---------------- ---•---•••.--•------ --._.. ------- -- ---- ---- ---- -- ---•-------•----••--- Final Inspection by --•.Date -- �,..� � .- 3 21� 1-68 Rev. 5 f SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7h 3g)