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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -1131 ..........................................._........_... ................ . .. (Complete in'triplicate) SCANNER - :......................................................... This Permit Expires 1 Year From date Issued 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..Ud,S. 'f� �._I�'.S'�. G.SPOI - G -/rIHX.z. lylpl7.CENSUS TRACT ..... ,................... e :..__:.... Phone . � ...:.« . Owners Name �14� ....- -5'-AN. x.14. ................... o -- Address/0.527:--V---/ -i-r --M--...._ 1. Cit r Y l�k�h.l�-o.P ...... :. ....... ....: ...License # _:.._._... .... Phone ---------------.......... Contractor's Name .----Q.CRl./(lG:fZ-�---------=---- ------------- - - •--- .. Installation will serve: Residence RApartment House f] Commercial ❑Trailer Court ❑ - Motel ❑ Other ........:. • ---------- -----`�--`..._._.:._ Number of living units:..-:.'I:- Number of bedrooms ...3......Garbage Grinder :._.._ Lot Size ................•• t Water Supply: Public System and name ..�( . 94_!" -----•-• ---....'-- ------...Private ! Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 1 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.) 'I NEW INSTALLATION: (No septic tank seepage pit perrttitted if public sewer js available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK- Size--fa2�: _-7,.4'-_'I07.---.:_ Liquid Depth .. ..:.......... ...... Capacity .. iwZ4.T--Type Gc/11 �!r_. _=Material R.. %/N.�°,11}CtNo. Compartments ._I. �._......:_. Distance to nearest: Welh . ._..arS..FT;.__'.`_::_.._Foundation /�. _ Prop. tine .._ = ( � s i Q � EACHING LINE No. of' lines .~ :_._....._ Eength of each Iine..ffaT... ........... Tota! Length .-_ .__- ... ._ Foundation 1d_-:! -- __....;. Property Line _._��..... r�k-�7`...__De th° Filter Material ...1 ........... ........:.. ..... Distance nearest:, We Material _ r 1 SEEPAGE FIT [ } Depth . .. .... ._. � ---:.. iaiameter•-_-._:_.:-:---.-Number•-.-.••.�-_- .-::............ Rock Filled Yes No �[ w Water Table Depth ...........:_---------------------------- ........Rock Size ....... ••. ..............- Distance to nearest: Well ................ .................Foundation _._:..---- ......... Prop. Line ......_............ .. OEPAIR/ADDITION(Prev. Sanitation Permit# ----- Date ) Septic Tank (Specify Requirements --- .... ----- ... Disposal Field (Specify Requirements) ------------------- ---------------- = = ..--------- -._.. ........-- :.. - -- ......-------------------------------------- .. ------------ ---------------.------------------------------ -- ---------E-----.._.......... ----. -- (Draw existing and required add-itiori on reverse. :. s 1 ...... ................ rse side) hereby certify that I have prepared this application and that.the work will 'be #lone in. accordance with San Joaquin F County Ordinances, State Laws, and Rules and Regulations of te San'Joaquin;Local Health District, Home Owner or licen- sed agents signature certifies the following:. "I certify that in the perfoemarice of the work for which this permit is-issued, I shall riot employ any person in such manner � as to#seta s b' ct t arkm "s Compensation laws of California." Signed .: r -- .-._... Owner �• By . Title ; .... .. . . ....... ...................... •. (If other than owner) " O -DE RTAff NT USE ONLY APPLICATION ACCEPTED BY ...-- .. ---•-- ;.. DATE ....- '/ BUILDING PERMIT ISSUED ....... �...................... __.......--- -.. ..<..._._.,.._DATE . ----...._.... :-. ADDITIONAL COMMENTS ..... . _. .... ... . .......... ------------ ....----- ---------.................... ...... .................•---..._ ... __.. ...... ... ---- .. . . . ------ -- -- - ...... ...... ........... .. .. .. - -. ---- - -..-. ----- ..... .-----------•----- ------------------ --- -- - --- ... . _.. .. = i ......._..... Final inspection by: E..............•..Date = �� r ...... y SAN JOAQUIN LOCAL .HEALTH DISTRICT c u 11 24 7/72 3. 211 _