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FOR OFFICiSE" APPLICATION FOR SANITATION PERMIT t Permit No. _-- ----- --- ------- -------------- ---------- (Complete in Triplicate) ---------=- ------- ----- ----- Ddfie Issued I This Permit Expires 1 Year From Date Issued ----,------------------------- i hereby made to the San Joaquin Local Health District for a permit to constru sting and Rule7 ta�nd Regulations- pp' egulat ons- l the work herein Application s y ► des.cribed. This a plication is made in compliance with County Ordinance Na. 549 an ex i 12tc?,57— r , // /I_IT _F} CENSUS TRACT --- ___�- [ JOB ADDRESS/LOCATION - irl; l- --------- .�_ '°-� M --------------------------------------------------- ------------------------- - --_Phon e . Owner's Name -.1:-^�A-.I0- �w Address ! Ph w _ - --------- city -- - -- Contractor's Name f�' License#� r ��1 one t Installation will serve: Residence F1 Apartment House❑ Commercial ❑Trailer Court ,E] t � Garba�ge/ u'" { - ---------Motel ❑Other -Number of living units------------- Number of bedrooms Grinder ------------ Lot Size Water Supply: Public System and name ---------------------------------- -----------------------------------------------------_ _--_"__4 2_,___Private� t Peat Sand Loam Cldy`�Loam;❑ Character of soil to a depth of 3 feet: Sand' Silts[:) Clay ❑ ❑A Y ❑ 1 w p ❑ , , -. oiF f_ e.s,.. ewe.= ± - Adobe Fi�Material— �,1.-Y tY : Hard an � .. a� ,:.:... �.:..:....._.�.-�._;,.., i (PI'ot plan, showing size of lot,' location of system in relation wells, buildings, etc. must -be place'd; on reverse side.} O P Li id De bet,) p seeps pit peri Site d i fpublic s w risavailable witghin 200+pth ._ +---------- G NEW INSTALLATION: (No septic tank or PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] aterial_C&I' j__-- -- moo. �Comparfiments ------------------ Capacit -------------------- Distance --------------- Type ` f F' P -------- LEACHING � � Distant+ to nearest: Well _--t'�� -----------------Foundation -""�--- ----- ";-- Prop. _-._____�.---------- Len fih[of each line-_-- --------------------dTotaL Length _____�----•=== LEACH WG LINT; [.}fNo. of;�ines -_ /----------------- 9l ! � � !� -•-- D' Boz .____- Type Filter Material __ " -Depth Filter Material _--/�--------------�,-_-_._-- 3 K I Z'1 f Property Line. Distance to nearest: Well __�_____________.-- Foundation -.-_ __-a------ - - P t'fiY $' SEEPAGE PVT [ ] Depth ------------------ Diameter ---------------- Number -------_:------------------ Rock Filled" Yes ❑ No 01 a vi ock Size ?7i : \ .. Water Table Depth S :- - �- i Foundation ------------------ Prop. Line - -------------- Distance to nearest: Well --"------------------ -- _ C {1 s ----- --------- ------ Date ------=--------------------------- REPAIR/ADDITION {Prey. Sanitation Permit# -------------------- f ' - - ``----------------------------------------------- Septic Tank {Specify Requirements} -------------------------"--------- ---------- --- ----- - ---- - ------ Disposal Field (Specify Regbirements) ---_Dki I N Lr� g �J - �An�JK----- 't---- »''�' .© --------- �94i- -� 'r X g and re w i existing f .. -- ----- .. -------- (Draw ired addition on reverse side}� �-�� ` l hereby certify that 1 have prepared.this applicatioR,and that the work will be done in accordance with San Joaquin County Ordinance,-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, I shell not employ any person ijn such manner as-to-become subject to Workm i 's Compensation laws of California." i l i Signed :- , -._� tle -- -------- Owner AL B.Y --- (1f other tha3n owner) i -' FOR .DEPARTMENT USE ONLY t APPLICATION ACCEPTED ABY _-�- DATE ---- =�p� �_` = DATE ---- ----------=------------•--------- BUILDING PERMIT ISSUED -----t--------------- -- --------- ----------------- i at ----------------------- _.�- ADD171QNAL-COMMENTS, ._:< _ .- - - -------------- --- -- � ti ------------------------------------------------------ ------- -- -- - --- ------ ---- -------- Inspection- . -- - - ---- --- - ------- --------- ------------- Final SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.