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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT .,'----------------------------=--`- IM - 517 Permit No- ------------------ --- .� {Complete in Triplicate) , -;�,;. . -------=-- ------_------------------------------------- (� 0_# —' co �.; This Permit Expires ] Year From Date Issued Dtrte 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. p n� f JOB ADDRESS/LOCATION �'`7 75 ---- -----F!9_IV.bE-F�--------------------------CENSUS TRACT �`�J p p Owner's Name 0- l i_ 1\------------------------------------------- '------Phone --------------------•-•----•-•------ Address ------- 7 �[ S-------------------------------- Cit : •--------------------------------------- Contractor's Name ----OLVNIZ9---- --------------------License # - ;:------------- Phone ------------------__ Installation will serve: Residence ❑Apartment House❑ Commercial ❑Traile ]} Motel,0 Other -------------------------------------------- Number of living units:------(-_-__ Number of bedrooms ---/-------Garbq�e Grinder _O-__ Lot Size --��-_.-�4��_E� Water Supply: Public System and name_____________ __ - - ©- - -------------------�--------------------------------�- ----------- ---- •- .�-•- •--Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay El Peat❑ Sandy oc lay Loam [] Hardpan ❑ Adobe '❑ Fill Material __ =-lf yes,. I ---------- ----------------- (Plot - ---(Plot plan, showing size of lot, location of system in relation to wells, building c. rr st--be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer/is available within 200 feet,] PACKAGE TREATMENT { ] SEPTIC TANK flrr/ Size- _�____X-1 _ -5- ------ . LigWd Depth -_- - -_- Capacity 1%ZO0------ Type i-Ot�ft��- Material l�NL � Na rCompartments ---_0'..---�.... Tw /] r Distance to ne st: Well _____ _ ____ _f___ __Foundafion ---A ___7"7__ Prop. Line .-Jam_____________ _ LEACHING LINE No. of Lines _________._ Length of a line_:___ � � a, ----- -- - g � ��=---=--�----._ T�dl Length`-----� ---�----••---- 'D' Box j�_S_ p Filter Material!_]_ G ____D __ ---- ---------------------- ....... Distance to nearest ell ____1.?5__�---- ______ Foundation _./Q__________-c--. Property Line SEEPAPITION(Prev. Depth ________________ iameter ___ ____________ Number ---------------------------- Rock Filled Yes ❑ No 0 W ter Table t - -------------- ------------------------------Rock Size -------------------------------- D s once ea s . Well ----- ----------------------------------Foundation-r-----f-------------- Prop. Line ...................... --- - I REPAIati r it# -------- --------- -------------__-_-- Date --- ............-------------____-} Septic To k {Specify Re nt - Disposal 'eld (Specify 1.ements) ____ _____(ITt_�jQ__---___-5r._5_5� __.__._ --------------------------------------------- -------- � ---------- ------- _ -------- ------------ ------ ----- - -------� __�__ ----A_�rfC4 --------------------------------------------- j (Dr w existing and required addition on reverse s{de) _ -- I hereby certify t t I ve prepare this application `and that the work .will be done in accordance with San Joaquin County Ordinances, State Laws, a Rules and Regul+ations'of the San Joaquin.Local Health District. Home owner or licen- sed agents signature certifies the f (lowing: "1 certify tha the p rFormance of th ork for which this permit is issued, I shall not employ any person in such manner as to becom ubiec to Workm mpensation laws of California." j J' Signed _ -------- --- -- ----- - - - - -- ------------`------------------�------- Owner By ---------- - ------------------------------------- ----•-----rs_ft COL--- Title ----- --------- ---- - ------------ ------------------------------------ (if --- ---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------Fr_9_ 0------------------------------------------------------------------------------- DATE ----- ------ BUILDINGPERMIT ISSUED ----------------------------- ----------------=----------------------------- --------------DATE _.------------------ ---------------------- ADDITIONAL`COMMENTS -------------- . _ . - _. . - - - ---- -------- .- , 4 �_ - ___________________________ _-_-__..__._ .. ______________________ ____ ___________________ _.__ L --------------------------------------------------•---------------------•----- _____________________________________________________________ Final Inspection by: ------------------- ------ ------------------ -------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M