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i a FOR OFFICE L!`�` r APPLICATION FOR SANITATION PERMIT F(Compiete in Triplicate) rmit No. ----------------- ----- This Permit Expires i! Year From Date Issued to Issued .—.7- _7 Y Application is hereby made to the San Joaquin Local Health District for a permit to constru tall the work herein described. This application is made in compliance with County Ordinance No. 549 and existi and Regulations: JOB ADDRESS/LOCATION -.� 7, f � -__--C:ENSUS TRACT � Owner's Name Qr ---- (J- - -------��-tl-.-SE.K ------Phone ------- ------------------ Address .��.•�yo-------l�141.L�-Q �-- -- -- � ---- -------------------------- . -------------- City L �1�_(1I-TOA------C?I/5( . Contractor's Name -.OiRJ+'V- [ - --------- ----- - ------- ---- - - ------.License # --------- -------------- Phone - --------- ----- Installation will serve: """"'------� Residence2-Apartment House❑ Commercial ❑Trailer Court ;❑ Motel [I Other . Number of living units.-... .-.__. Number of bedrooms - AA � �jj p .------Garbage Grinder LvU-- Lot Size Water Supply: Public System and name ._ ... •----- ...... .... �y ------------------------------------------------------------------- ------- --------Private E]Character of soil to a depth of 3 feet: Sdn Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardp ❑ Adobe ❑ Fill Material .i If yes, type -..--------__----------- -- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or epage pit permitted if public sewer is avail ble within 200 feet,} PACKAGE: TREATMENT [ ] SEPTIC TANK ] Size. ---- Liquid Depth -------------------------- 'Q Capacity ---------- ----- -- Type -------------------- Material----------.----- No. Compartments LN Distance to neares : Well -- ------ -__ ---_.Foundation ----- --- ---------- Prop. Line -------------- ----. `N LEACHING LINE [ ] No. of Lines - ------- ---- - ----- Length of each line.......------------.- ------ Total Length 'D' Box ..-__--____ Ty a Filter Material ....................Depth Filter M teriai Distance to nearest Well ........................ Foundation ___.._-------... _---. Property Line ...._.- ----------------- SEEPAGE PIT [ ] Depth --_- .-.------- - Diameter --------------- Number ------.-.----------- ------ Rock Filled Yes ❑ No i❑ ` ,. Water Table Depth ------------------------------------------------Rock Size -------- --------- Distance to neares Well ----------------------------------------Foundation --- ------- Prop. Line --------------------- REPAIR/ADDITION(Prev. Sanitation Permit ------------------___-----._ -._ --_---.__ Date --------------- Septic Tank (Specify Requirements) --------- ------FXA_$-r1_N_C Field (Specify Requirements) __-/170 ------C�P'�___-. (;�Ka-"T`�_---___--- -- --j-- ----`�.nk. -- -------------PJ �-------1�3-;0-K----------�_--- ------�F------- -2�= - -------- - _ --------- O- w raw existing and required addition on reverse side) A RE�4-S I 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. Home owner or licen- sed agents signature certifies the following: "I certify at ' the p orm nce of the work for which this permit is issued, I shall not employ any person in such manner as to b m bject man's ratio laws of California." Signed `------------- Owner By -- -- ------------------------------------------------7 f A_V_'--- Title -------------- -------- (If other than owner) FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED BY ------.T1.f\ ` DATE ---- --------------------------- -- BUILDING PERMIT ISSUED ----------- ------------------------- -------DATE ------------------------------------------ ------------------------------------------------ ADDITIONALCOMMENT -------- --------------- -------- --- --- ------------------- ----------•--------------------------------------=--------•---•----•--------- -- - ---- -------- ---- ------- ---------------------------------------------------- -------- - ----- -------------- ------ ----- ---------- --------------------- ------------------------------------------- - - - - ---- Final Ins ion b -'-------------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M