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+FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT- ----------- ------------------------------------ I Permit No. 7Z_-311 o plete in Triplicate) 6----------- Tis PerEx irerlf Y dr,Frorn Date Issued Date Issued .-- _-__7._7_?! mit Application is hereby ma a to the San Joaquin Local Health District for permit to co%ruct and install the work herein described. This applicatio is made in compliance with C unty Ordinance No. 549 ani e-isti g Rulesiand Regulations. IIDa-F 1� IF"j, �� 1(14i.19JCD VV.* C�zf2,rlt waw tz 13 tJori l4 EteFr' v�J-PICp Rb JOB ADDRESS/LOC f3wv 1W --Cf' I L._ _ iet --- --- .-- ---!tENSUS TRACT -------------------------- Owner's Name -..Awl. .----Qllt-N14--------------------------- - Phone Address r �'� .-ST4 f----------------- i# Y --------- Contractor's Name --------- -5 ------------------------------------- -- License # ----- ------- Phone ---------------------_------ I -----------------.._...- •-- Installation will serve: Residence D64artment House❑ Co mercial�Trailer rt ;❑ E Mo el ❑ they 4 ---------------- --------------- Number of living units: ____.____._ Numbe�f' be~oom LoT Size 1-5-j'00-4-__S- ' f-__ Water Supply: Public Syttem and name A-.0__-- ------_-_----- . ------------------_........ -..._.._. ........_ --•__ Private Character of soil to a depth of 3 feet: Sand❑ Silt ❑ Peat❑ a oam ❑"'"CI oam Hardpan ❑ dobe ill.Material -------- Iyes ?ype --------------`_------------ (Plot plan, showing size f t-,,loc ono t i � to wells buil -i s, etc. must be plat'd on reverse side.) `\ NEW INSTALLATION: Kl se tic tanhor s e a e it ermined if ublic se erg is vailable within 200 feet,) { p I , g p I p 1 PACKAGE TREATMENT? [ ] SEPTIC TANK�4 jr^ � Liquid Depth Capacity -- - -------- :-- Type �I+kl `_-- -- Material_a)4 _4- No. Compartmr4ts _1. .............. 4441 fjfpittar,ree to neare t: Well ---------. _; 'f,e& __Found ti n _ -_ _j4f_et ,� LEACHING LINE No. oOrkin�es ---_-__ Length !e .,�l' e ___ Total Length"P_V_Aa_e�____ 140-4- � Box ._ Type Filter Material SO_f_IG_f4cJL epth Filter Material --_-__� ______________________________ _Dista o nearest: Well ____(V(P ____ Foundation _._�©- Gf-- Property'Line _---5-�_t---_SEEPAGE PIT [ ] Depth-- I Diameter ________________ Number --------------------_---____ Rock Filled Yes ❑ No i❑aterTC le Dep#h Rock Sizesa ico4nedrest: Well ----------------------------------------Foundation -------------------- Prop. Line ----------------------REPAIR/ADDITION([rea anitati n Permi -------------------------------- - Date ___-____________________-________-) i SepticTank {Specify Requirements) ----- -- ------------------------------------------------------------------------------------------------- ---•----------------------------- Disposal Field I pe,ify Requirements ----_-----------_--------------------------------------------------------------------------------- ------------------------------=----- ---------- ----------- - -- ---------------------------------------------------------------------------------------------------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 accordan a with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Horne owner or licen- sed agents signature certifies the following: "I certify that i rfor ante of the work for which this permit is issued, I shall not employ any person in such manner as to I�ecom s to W kman's Compensation laws of California." ,. Signed ---- --- By -By ------ ---------------------------------------------------------------------1 T6it,le --------------- - ------------------------------------------------------ (if other than owner) FORD PART USE ONLY --77 APPLICATION ACCEPTED BY DATE .------------------------ --------------------- --- --r f'- ------- BUILDING PERMIT ISSUED ----------------------- --------------DATE ----------------_ - --------------------------- -- ADDITIONAL COMMENTS ----------------------------------------------------- --------- ---- - -------------------------------------------------=--------------------------- - -------------------------------------------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------- ------------------------------------------------------- ----------------------------------------------------- -------- - -- Final Inspection by: ______________ Date ___. _ SAN JOAQUIN LOCAL H H DISTRICT E. H. 9 1-'68 Rev. 5M