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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------- ------------------------------------------ Permit No: (Complete in Triplicate) --,--�---.,.--�----- ------�-------------�-------------- - `��_ --------------- -------.-------------------_--------------- This Permit Expires 1 Year From Date Issued Date Issued _67// CAL -V Grt- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance Na. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . �� .....S...... tf'_ `------------------------------- --CENSUS TRACT -------`-------------- Owner's Name ------------ t-✓ _ ._Phone Address --------- ' 4:! 5---------S-----------SjF�-f_D_N F -------------.City flLQ '------------------- ----------------- Contractor's Name _ ---JA+ S_ 1<3._ C1K -_ 0-__�-License # ---------.----------,- Phone s_----- _ 3 Installation will serve: Residence @Apartment House❑ Commercial:❑Trailer Court 0 Motel ❑'!Other "rt te ; ir -------,�,----=--a---'=-------------------------- � Number of living units:-----!------Number of bedrooms ----7r__.Garbage Grinder [Y Lot Size Water Supply:'Public System and name J t ------ v^ - Private ®� Character of-soil to a depth of 3 fet: ._.Sand❑-..Silt❑._ Clay-p-._-Peat�] SandyrLoam �._Ciay Loam ❑��- rte Hardpan � Adobe-❑ Fill Material _A) '__ If yes, type >___________________________ (Plot pian, 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 sewer is,availaple within 200 feet,] i PACKAGE TREATMENT f ] SEPTIC TANK[ ] Size *!Q_X� Liquid Depth ...... ___,_____ Capacity�'to �_ --,__ Typa __ _ Material__f17hJ.1�-___ No. Compartments _______Foundation ___.____._/D Pro Line _._ Distance nearest: Well ___._=-�_________,� __ _ _______ p. _._�___________ �1 LEACHING LINE [ ] No. of Lines �____________ Length of each line-,_ _`_____________ Total Length ,____: ---------- - D' Box _ Type Filter Materia! Cl C��'_Depthjilter Material ----- P7t. Distance to nearest: Well _'_______�P___ Foundation ------ i_10-_____ Property Line, ________________!K. a, �a SEEPAGE= PIT [ ] Depth rZ Diameter _XV-_- Number .__.:_lzi -- Rockfilled ,Yes 21' No .0 4 Water Table Depth ------------------------------Iva Size ----_-.- .- ..� - - — Distance'to"nearest: ___Foaildatian -- n__/_O---- Prop. Line ------------._::.______ r REPAIR./ADDITION(Prev. Sariitatiom Permit,# '--j_.__ "- -- -= ....... -------- 1. Date? ---------------------------------- ------------ Septic ------------------------- ---_--- Septic Tank (Specify Requirets)------ -� - ---- ----------- ------------- ----- t -------------- ------------ _ ----------------------------- Men Dis osal Field (Specify .Requ.irements) --- ----- -----•--------------- s�_ ---------------------�_---,.___ _ f^. - - - •:-----------r_ -. _- (Draw existing and regvirediaddiiion-on-reverse side) hereby certify that I ,Ilayp�_prepare'd this application and that the work will be done in accordance with San Joaquin County Ordinances, Sfaie Laws, and Rules and Regulations of,the San Joaquin Local Health District. Home owner or lican- ,sed ogeAts signature certifies the following: "I certify that in the performance of the work for which this permit,is issued, I shall not employ any person in such manner as to become ublect to'Workman's C e t_inn-laws of California." /CDI Signe `- =t IjOwner _: B ' - Title ---- . [- � (If other than-ow.ner),, FOR DEPARTMENT USE ONLY Q APPLICATION ACCEPTED BY `777R 7 7 R `I -------- -------------- ------------------------------- -. DATE - -w_+f '`� - BUILDING PER'M'IT`ISSUED', � ""'"' » `" " DATE" - ___�._- -- ADDITIONAL COMMENTS ----CWTB,-__D_I� AI4lf(: li- '_R3> iT�l� p ' 'r` � �—�7 �a�s._ _ P-IT-_OP is ►�o'sr a]f;N_o t[<1!_�=`'", - .r'= =_M- `t= 9-r -C9r __`TJX K IndP.RP fW' a L -fIC#f •LiALE2N DZ F_-'K- -lY�al�lf `� W IL-4 N-0T LNST-A-In _V- - �TtME aF QR�v]+ a'�u R = --r--------a e-- -c�- ) ^r r� Final Inspection 6fR411u .z Date NEW .5Ff-TI L D�/�_ SAN JOA Q N LOCAL HEALTH DIST CT 6 __ �1- E. H. 9 1-'08 Rev�MJ- ,,,,� 1� .