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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..---------•----•............................•-.,: Permit No. )Complete in Triplicate) 3�3/. 76 This Permit Expires 1 Year From Dale Issued Date Issued .................... Application is hereby made to the San Joaquin Local Health District for a per 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 ..-. 71�6 -.��._ �.�K��.....�!!�!�.............................C1rNSU5 TRACT ......... ............... F Owner's Name ._._J1.l71f�� "f' -ISI A ?" �?"�1:'f -... ............:........::...........Phone l.�0... .4115.......... Address ---....... �+ , J9N _ ....1`� 'a'• city .., . Contractor's Name . -- m_��-i .-- -6ah��.+" !!f��. ✓_ 1j0 License# ' .(JJ�i, � .. Phone :_�1� [ ... Installation will serve: Residence Apartment House mmercial flTrailer Court E] Motel ❑Other.-•----------------------------------------- Number ---------- --------------------------Number of living units:- . Number of bedrooms _ ...:...Garbo a Grinder Lot Size Water Supply: Public System and name ' �i��.L—..........................................................................................Private Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat O Sandy Loam 0 Clay Loamsd f Hardpan 0 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 jewer is available within 200 feet,} 1� PACKAGE TREATMENT [ ] SEPTIC TANK Size.. _..X_�.__Ca__ . quid depth _...-:i } , Capacity ra�f� ,..... Type --•----_---- aferial.... . . No. Compartments i D � Distance to nearest: Well ...../&O..................Foundation ........ Prop. Line...... LEACHING LINE No. of Lines ------A-_---__.._--• Length of e `1i ..--...7.c�..�.-.-.---- Total Length . m..�5.......•..,---� - /� D' Box ... Type Filter Materia ....................Depth i t�Material .........416"I-r.............,....- 6 Distance to nearest: Well _....l..G. ._.... Foundation ....J.Q..1.......... Property Line t ...... Rock Filled Yes Z No r SEEPAGI; PIT Depth ..... Diameter Diameter ,/t Number ..._.__. ._ T Water Table Depth ....................... .................Rock Size -------------------------------- Distance - ------Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... } REPAIR/ADDITION(Prev. Sanitation Permit# ........:..,................................ Date .......................:....----.•) �h Septic Tank (Specify Requirements)............................................................................. Disposal Field (Specify Requirements) ----••-- ••-••---------- ................................................................. ------- ............................ .. f •-------•--••••-••--•---'............. ..............•--.---_ ------_ __-__._....--....._-_..-......-----•_•----_--------_--.----------_.----•---...----..-......................-......_...._._....... --------_----_____________________________________..........._....._............_.._.._._.._____..___..__........................_..........7 [Draw existing and required add i#ion on reverse side) �i\p 1 hereby certify that I 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. Hosie owner or licen- sed agents signature certifies the following: "1 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 subject to Workman's Compensation laws of California.". t Signed ---- --- ---- --- ----------p-------- - Owner G�.s 3itle _..( _w'�!. :'t - C_Un� o er than d _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r__Zlev •-••-•---------•-------- DATE r BUILDING PERMIT ISSUED _.. .................DAT£ -----------•-•-•------------------..._.__.. ADDITIONAL COMS ----- ------------------ '-- �' ...... ............. -------- e -- Final Inspec b �� ....... ._.....Date ... ✓ P Y' •----- _ . . -,ice �-,-= - EH 13 24 1-68 1iev. 5M SAN :IOA N LOCAL HEZI:IH DISTRICT 8/74 3M t