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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - - ------ ------ -.----- Permit No: (Complete in Triplicate) __________.__-_ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Loca! Health:D[strict for a permit to construct and install the work herein described. This application is made in compliances.with-Co,unty..Ordinance No. 549 and existing Rules and Regulations: JOBAD�7RE$$% bCA7lON ._::= '1:: - - 4 - FIS. - - - - - � T- _CENSUSj7RA-CTS-°:-__: _______. Owner's Name Ronald TAO rP a Phone.___ _7-1-980___._ - ---------------------------------------=- ----------- AddressSame --------- ----------------------------------'------`--.------ .. City - Stkn----------------------------------------------------- [ Contractor's , NameBlaak r_d_r.S.__Sf;ptl-C---`I'a k----------- ----------License #268-9-X51--------- Phone ------463.x-7-a4-8---- Installation will serve: ResidenceE]Apartment House°❑ Commercial:❑Trailer Court r # Motel ❑Other ------------------------- Numb%er of living units:_1--_______ Number of bedrooms __3 --- Grinder ------ ----- Lot Size -._1� __ACTe___________________ Water Supply: Public System and name ------ _ -PrivateJ.; --------------- Character of soil to a depth of 3 feet: Sand'Q Silt p Clay ❑ Peat❑ Sandy Loam [] Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type __________________________ {Plotplan, 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 feet,} PACKAGE TREATMENT Q { ] SEPTIC TANK'[ l Size------------------------------------------------ Liquid Depth -----•-•---`-------- j Capacity -�- ----------------- -------------- Type ----rM ----------- No. Compartments -•-.--•------ Distance to nearest: Well _____ ______ ____________ undation -- J- _ Prop. Line -- --' LhACI ZING LINE [ No. of Lines -----]-------`-_r---- Length of each I• e._--- --- �-- -- Total Length --- Q_ --------........... 'D� Box --- T __Depth Filter Material -1-`�- = € ; 1---- yp4ilter Material -_--- ----_-- p " r = I Distance to nearest;. Well __ r Found.atian 1Q Pro e Line �h6€BA�bi-i�l� Depth4?X20!___ Diameter __-__--0-!. Number ___._ ___ Rock Filled Yes ® No•i❑ rump l ----- Rock Size 2 n i Distance to nearest: Well ._____--- Foundation ` �� '� ---- Prop. Line ---- d, Water Ta , e..De th REPAIRJADbITION(Prev. Sanitation Permit# __-_-- w~ ---------------- Date -------) ' Septic Tank (Specify Requirements)/- -------------------- - -.: --------------------------- --------------- Disposal -Disposal Field (Specify. Requirements) ----- E ---4i_X1fafXl0Q-'--------+--:--- - M t -- S = �,� . ---------- ---- ( \ ' = '(Draw existing and required addition on reverse side) ! I hereby certify that 1 have prepared this application and that the work will be done in accordanc County Ordinances State,taws,.arid u e with Son Joaquin I Rles and•. Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies-the Following: j "I certify that in the performance of the work For which this permit is issued, I shall not employ any person in such mdnner as to become subject to Workman's C6t pensation.laws of California." ' Signed ''` ----- ---- - t_ $Y ---- -- wn ------- Title ' (If other than owner) ;, f c FOR DEPARTMENT USE ONLY APPLICATION ACCEP'ED BY,-------- -------------` r` alk_ DATE = ` - --------------- BUILDING PERMItl' SUED -ry - [ n. 1 - ----=--------- ----- ------ :_ ._;-------- ADDITIONAL COMMENTS --------------J - ----1 --------------------------- ---------------- ----------- -------- -------------------- ------------------ ----=--------- ' x - -------------- �= `------------------------------- --- Final'Inspection by: ---- ------------------ -----------------------------------_------------------ ""Date''_T Z /''72-..-------------- �- OAQUIN LOCAL HEALTH DISTRICT E. H, 9 1-'68 Rev. 5M r ,1