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��, APPLICATION FOR SANITATION PERMIT - .........-.......... `` " Permit No. _..za -�}'- (Complete in Triplicate) ............... p Date Issued ..��. --_.. This Permit Expires ] Year From Date Issued 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: JOB ADDRESS/LOCATION . _ LQ. .[.-..-- ._..C .-....� ................ ........-CENSUS TRACT ...... -'S..-------- Owner's Name ....... Q.J.-%V 7............... .... .... .........Phone Qwz..-..f 3 .............�.Oc�`Y -i�eC.-...---................ ty f-��n�.�n.....'CA� Address ..__ .�, �_ x'U�]7C Ci Contractor's Name .... ................:-------License # ....... :'_..... Phone .._..Q..7f -.l ?.3► Installation will serve. Residence 0(Apartment House❑ Commercial.❑Trailer Court ❑ " Motel ❑Other ....................... .........------_- Number of living units:.... Number of bedrooms ....Z..Gorbage Grinder ..00.^ Lot Size +.__AC'C s...•....... f Private A' Water Supply: Public System and name. •--..... _................. Character of soil to a depth of 3 feet: Sand❑ Silt.❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe'❑ Fill Material ...... If yes,type _----_-_----.._ (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 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK)�� Size.......................�_._--.__-..-._-._.... Liquid Depth 300 coal rout I �Q Q, , Capacity ...�D(a_ . Type . VAC.AJIZ ater101-------- -----_ .... No. Compartments �...._.____..._ c��w lar iav►k x 4 wt(I 'Vie- to 4a I}. 'stance to nearest: Well _So..._...................Foundation ..... ------- Prop. Line ..__5.............. LEACHING LINE H--lTo. of Lines .......Z........_ Length of each:line ------- Total Length .....L_ _ ------------ i 'D' Box ---K.... Type Filter Material KS44*n....Depth Filter Material ...-._.__-�_A._�...............1. ....... DisfaAce to nearest: Well Foundation .....J0_,<.......... Property Line ..___ '.............. SEEPAGE PIT [ j Depth Diameter ....... Number ........::77=n--.-----_- Rock Filled . Yes •Q----Nv-0 Water'Table Depth ..................................................Rock Size ........---_---- 1 DistaAce to nearest: Well ..................'_'"- ....__.....Foundation ......."_-~—Prop. Line ----.l.�------ ;1 REPAIR/ADDITION(Prev. Sanitation Permit# ............ .............'.'............... Date ................--------.......... ) I' Septic Tank (Specify ---6G.-404 _16X6---1A0 ._yd...rr1>`_4*1'.,_. Disposal Field (Specify Requirements) ...... .----,-•--•-•.................. . . ........... -------- ---- ----- •---------_..................... . . ........................ I......--- . •.......................•. - ..-..-----------•--.......... . (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and'thatfthli'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: - t+ "I certify that in the performance of the work for which this permit is issued, 1 shall not.empley any person in such manner as to become subject to Wo man's%Co ensat on laws of California." SigneLiCJ - - ,,zzo4G�- Owner ,_.--,.. By --------- ; .............. OW40-4............................................ Title .............. .. {(if other than owner) . 1, I. r FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY g. ..... ........ -- ••..----. DATE . /7 ............ BUILDING PERMIT ISSUED .__. _ ---....---••... ..............DATE _- .......... ....... .................... _.....:--•- --••-- ADDITIONALICOMMENTS .......... ............................ . •-•--•---••-. .r' ......... . . Final Inspection by: - ..;'._ . . - ...........Date ..c --��• --------�l.-----. • J SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M r- '• r�