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sJ A -- FOR OFFICE USE: r d APPLICATION POR SANITATION PERMIT m, Permit No. . �- -- --------_ (Complete in Triplicate)p p -- ___________ This Permit Expires ] Year From Date Issued Date Issued `'�3•- Z7.O 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: ' JOB ADDRES /LOCATION_ r4--------- /4,Ot-------------------------------------------------- ------------------- ----------CENSUS TRACT --1f ------•-----__.._ ----------------- -------------------------- Owner's Name __ TD G T--- I G_Ei2 - ------ ------c_._� -- --------------Phone ------------------ f I� --------------------------= = Ci d 0 Address NRw K7� -------------yfSV_ TO Contractor's Name _ _hRl21Z1 s-H V S Phone ------------------------_---- Installation ---------------------- - - a C -:__-----License'# -------- -- - Installation will serve: Residence ['❑Apartment House(❑ Commercial ❑Trailer Court ;❑ Motel ❑Other _-C-s0><----Z7TT jt a/__qo_-,-cL I�,�,�y� -(, En.1fa4�y s�01* -SNif--r Number of'.living units:-----------. Number of bedrooms .---________Garbage Grinder ___----_-.__ Lot Size _________________________ ----------- Water Sup = Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam 52'r I Hardpan ❑ Adobe ❑ Fill Material ___________ If yes,type __--_-._.___________ _____ ti f N s (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' i e per d if public sewer is available within 200 feet,) PACKAGE TREATMENT VSEPTIC TANK�!j�(J Size_ -- (4------------------ Liquid Depth ---- 1 Capacity Type _---------- Material---9_C_-_------- No. Compartments ---Z-•_-- Distance to nearest: Well _-___P6-�_-- /moi .i -------Foundation ----A0------------.Prop. Line ------ -------- LEACHING 1 LEACHING LINE . No. of Lines -----QjNc-------- Length of each line-_______A4 Total Length ____ �-_- -•---- j 'D' Box ------ Type Filter Material --------------------Depth Filter Material Distance to nearest: Well __-. ©_Q_.___t-_ Foundation _--_ -_-________-- Property Line. ____� ______... _ µ SEEPAGE PIT # " C ] Depth ----- ---x-------------- Diameter -------------- Number ----------------------_-_--- Rock Filled Yes El No 0 Water Table Depth ----------------------------------=----i--------Rock Size ------------------- - ------- Distance to nearest. Well -----------------------____________...Foundation ' --------------- ---- Prop. Line ----------••---------- � REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------- ------ Date ---.--------------•-------_-_--- -) Septic Tank (Specify Requirements) -------- ------------------------------------------------------------------------------------------------------ Disposal Field (Specify Requirements) ------------------------------••-•-------- -----------___--- 1 x ------------------------------------------------- = i -------------------- ---------------------------------------------------------------------'---------- l ----- (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 e County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liveni. t 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 `- -- Owner BY = ----- ------ ------------------------ ---------- ------------------------ Title ----- ( ' (If other tCw1r - .. ----------------------------------------------- FOR .DEPA:RTMENT USE ONLY '>t APPLICATION ACCEPTED BY ------------------------------------------------------- •-�-t�-n----=-------- -- -e------------- . DATE --- /-BUILDING PERMIT ISSUED � ^ ---------------------- -- DATE ------------L CO ADD1T NA ------ ' '� ------------------------------------- - -------------------------------------------------------------------------------- -- -------- ------------- -------------- ------- Final inspection by.. -- --- --- --- - -- D e SA JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re M.