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FOR OFFICE USE:— �V APPLICATION FOR SANITATION PERMIT {Complete in Triplicate) Permit No, _-�q ~ . This Permit Expires ] Year From bate Issued bate 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 --- L�j�©-�__--5'-_._C�i 11 le -------Q_&i--------------------------CENSUS TRACT ------:�3__-5.----------- Owner's Name --------puwI ,Lo-------- -!_ 1_ -------------------------------------------->------------------.Phone -114 ..°-_L513h --- Address ------- BQ --�?' 0 ---------------------. City ------- 2 n __._12 �4><Vti{G -- ------------------ Contractor's Name -------- --- ---- ------------- -------------------------- License # ---- - ------- Phone -.---Q_�f Installation will serve. Residence X Apartment House�❑ Commercial:❑Trailer Court Motel ❑Other ------------------ ------------------------ Number --------------- -- -Number of living units:___- Number of bedrooms ....___Garbage Grinder ._00-f Lot Size 'd w ___'____________________ Water Supply: Public System and name--= -------- ------------------------------------------------------------------------------------Private A' r Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam :❑ Hardpan ❑ Adobe '0 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 [ I SEPTIC TANK*-TJ Siie-------------------------------------------- Liquid Depth ---------------------.----- 300eel 5 chctQ, . Capacity ---of-Do-- - Type -, i(�"�tMaferial---------k---.-------- No. �ompartments ----�-------:---- G 't°�r �� x+S4, Distance to nearest: Well �� _ ---------- ----- -----Foundation ------ ____-- ------- Prop. Line __-- will lie- in +a I}. . +- ('LEACHING LINE o, of Lines !' I �� -------�.�'-------- -- Length of each:line-----------7.0_.__.____-- Total Length -----L_el.a-----____-- [ D' Box ---x_._ Type Filter Material !__00/—___-Depth Filter Material -----------I-S------------ _ a Disfance to nearest: Well ------ Foundation ...... ------- Property Line -----5. SEEPAGE PIT f [ ] Depth ------- ---------- Diameter -------�_:___- Number __.____-_�-�_ -______- Rack Filled . Yes {3----h4o-0 : I, Water'Table Depth ------=----------- ------------------Rock Size ------------------------------- t Distance to nearest: Well ----------------------------------------Foundation ------]`_" Prop. line ----__r---------- REPAIR/ADDITION(Prev. Sanitation Permit# ----------- ------------- ------}-.------ Date ----------------------------------] Septic Tank (Specify Requirements) � �" '�II�L�:--n6---b Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------------U j --------- - -- ---------------------- ------------ 'CA itl Cry c 151 'C � ------ -tre �,7��4 v► ; ---------- ------ - (Draw existing and required addition on reverse side[ I hereby certify that I have prepared this application and that Cthe-work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San .Joaquin Local Health Distelct. Horne 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%CO en_saaPo1n laws of California." Signe - ---- - —--- ._ Owner T By ----------------- -------------- " tff�---•----------------------------------------- Title -------------------- -�— Of other than owner) t FOR DEPARTMENT USE ONLY - i A-, APPLICATION ACCEPTED BY ---- � �----------------------------------------------------------. DATE -- � � ----------- BUILDING PERMIT ISSUED = DATE ADDITIONAL!COMMENTS -------------- ---------------------i - _--- --------------------- ------------------ ----- --- ---- ---------:--- ; s — y � r---- _. -_. ----------- I J-- (� IFinal ns ectibn _--___..Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ti ..