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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ....................... .............. ?y-a�S (Complete in Triplicate) Per No. ..................... _ This Permit Expires I Year From Date Issued Date Issued .' : 7.. Application is hereby Modi to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made`in comp]!a it County Ordinance No. 549 a d existing Rules and Regulations: -yrince� rz e o o _ •. . _. JOB ADDRESS LOCATION SPERRY + NEW HOLLAND, Marengo Rd. � CENSUS TRACT Owner's Name E�._... '�1y�k Sott.. ............................................................_._ ..Phone -�'�^.�7...:' r......--- 1 Address .............:.11:x.--iN'P-= _�n?�"' :....:... cty h_� . ��........_`, 703 ... .:. . ` 0� 0L n s; 477 Contractor's Name fj. . N. . --l1►.-- --•-........... ..•...•.License # 2-54-94.1.--------- Phone Installation will serve: Residence ❑Apartment House f2 Commercial ❑Trailer Court C Motel ❑Other ........................•--................. Number of living units:------------ Number of bedrooms ............Garbage Grinder .......... L. t 'xe . A .m$ nop Water Supply: Public System and name .cl s+._ .... ---.. .- .1 P.r____----I —......... .................Pri�te � r Character of soll to a depth of 3 feet Sand'❑ Silt[] Gay Peat El _Sandy Loam-.0 Clay Loam ❑ -.,. Hardpan.❑ Adobe Fill Material ............ If yes,type -------------1............ -• (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,) I, PACKAGE TREATMENT SEPTIC TANK t 1 Liquid Depth _ ......�....... "�- GCapacity Type ......... ... No. Compartments .......... .I Distance to nearest: Well .........................-..Foundation .q2----�-_F. Prop. Line LEr�HING LINE [ J No. of Lines ...,�---------------- Length o ea line-----/0.C?----I_F. �Total.`Length ----��.Q. r..:_.. . � a l I 1! 'D' Box ....�_.. Type Filter Material :74A...al� th Filter,Moterial ---.N................................. ,eve -� �. Distance to nearrest: Well ........... . .. ... Foundation - .. Property- Line .-. ,_._..__........ . -- --------- r • SEEPAGE PIT [ ) Depth --- ........ Diameter N tuber ......... ..... Rack Filled Yes�' No �- -� ��+Z r P 2 ,'�tr VeJ Water Table Depth _... _...: ....Rock Size .. .:..............•........ Distance to nearest: Well ....... �......................Foundation . ��.�©Q.�.: Prop. Line ..................... REPAIR/ADDITION(Prev. Sanitation-Permit+# T ...Date ... '..........:::......:: Septic Tank (Specify Requirements) DisposalField (Specify Req(jirements) ....................----............................_................................................................................ ..........................•----------------..._._.....----------------.....--••-----•--------------------.... ...................................................-............__...-•••••• ------------- ------------------•-•-------•---- ----_...- --....................----•----- ------- -.................,-•-•----• - ---------------------.-_-.-•----I.................•---- (Draw existing and required addition on reverse side) , 1 hereby certify that 1 have prepared this application and that the 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become sub o orkman's Compensation laws of California." Signed . _ ..... _. . ----------LGo---- 1/nl.................................. Owner By .... ........ .. _ .........'_.------------------------------------_----------.._.._.__._:_...:._...__.. Title _._.. ----------------- other than owner) FOR DEPARTMENT USE ONLY C ' APPLICATION 'ACCEPTED BY ......... --• . ---......� .................... =....-••-••......--•---.. DATE ..... 7......_._... •••--. BUILDING PERMIT ISSUED ..__..•. :. ..............................•..................... . I- ._ -------- DATE .............-••..-..-.•....•...... i ADDITIONAL COMMENTS .......................... ..------•----------------•--------•--•--•---......--•..........• •--•---•-----••-•-. ....................... -..............--•....:...........--------. -----........... ..................................... .---••• :---•------ .................................... ............................:.......... ......... ...... .... .._ .: ..__.. ................................... -• .---- ---•-- 00.1 FinalInspection by: ....... . ... --•.........:............••-••--------------•--................---....-----•---•--.Date _}... ._. ...Z ... --•------ SAN JOAQUIN LOCAL HEALTH DISTRICT Y G �, 13 24 SAA 7/72 3 M