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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------I-------------------------------- Permit No: 2_3— (Complete in Triplicate) --------------------------------------------- Date Issued - 3-------------- ----------- --------------------------------------------- This_Permit Expires ] Year From Date Issued_! y i r Application is hereby made to the San ,Joaquin Local Health District for a permit to construct d-Nd install 'the work herein described. This application is made in compliance with County Ordinance No. 549 arid eRi'st,ing ules and Regulations: JOB ADDRESS/LOCATION -----!27 1-/--------1E. V-1-17V-�------------------ - ---------'.� C U,S TRACTi _4_ OwnersName ------W......0_------ ------------------------------------------------------------------Phone --------:----------•--------------•- Address 2.743!- --------- ------------------ ------------ City C14-LQ---------------- } = ' Contractor's N me-4- F��l�_U_j�_._.�Efl ER------5 RY�_C.E--License # ---------------------- - Phone --E__-.-`---.-------- -------- e❑ Commercial ❑Trailer Court ;❑ "1 1 Installation will serve: ResiidenceKApartment Hous Motel ❑Other ------------------- Number of living units:-----)----- Number of bedrooms _3_____Garbage Grinde I . Lot Size _ 4_ --V-----+---- f i , Water Supply: Public System and name ---------------------------------•------------------------------------------- -------------= ±--------- i Private E�j� Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam F � Hardpan Adobe E] __Fill Material /0_ If yes, type --__-�±__________ - i t E (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc. must beiplaced on reverse side:) NEW INSTALLATION: (Nof,septic-tdrrikor seepa e_pit permitted..i.f_public_sewer-isjavaiI able witlirn!200 feet,) �y PACKAGE TREATMENT [ ] SEPTIC TANK [ ] [ ~Size!-----------------------,-_---- -- ------------- Licj6q!iJI Depth;-------------------------- V Capacity -------------------1 T pe ------------ -----# Materia)-......;------ No. Compartments � ------••-- Distance to nearest: Well -------------- #_- -------------_Foundati0 ----------------Prop. Line -----------_-------- V 1 �r LEACHING LINE. [ ] No, of Lines ---------- ______ _____ Length o each�,line\__.�s_: __ Total Eength __ _ _____________________ I 'D' Box ------------ Type Fi! er Material ---------r....------Dept' Filt Material --- ------------ '--------------------- Distance to nearest,Wel ________________________ Foundation _N__ ------------- Property Line J--------------------- SEEPAGE PIT [ � Depth ----------------r''' Dia eter ---------------- Number -------.--_� ------------ Rock-Filled Yes ❑ No 0 Water Table Depth ------- ------ ------Rock Size - ----- --------------- -o ----------- Distance t!- ' [ Distance to nea/est: Wel i - ----Foundatio f o9p• Line------------ ! � REPAIR/ADDITION(Prev. Sanitation Permit# ------ ---------------------------Ri --- -- Date -------- ___ ------------- - V Vi i Septic Tank (Specify Requirements)f _��---------- ---- -------; i ------E-----------:--------- Disposal Field (Specify Requiremei s) ..5 P-Tt-�----�4q- , ------B-6-F_FG-- r-----�-'------ l� T-----------C-6&/V QCT--- - -j--t4-c- �_�f ----------- -- F (Draw existin and re ui ed aOi- dry re4&se side) I hereby certify that 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 that in the perform a nce-•of-the-work-for-wh':ch-this-permit-is-issuedj-1-shall-not-em play any perso. in(such manner �f as to bu 'ect to orkman's Compensation laws of California." Signedeco + ---------------------------------------- ------ Owner € _.__ B --------- -------- Title .- � (1f other.'than owner) 3 pp FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- l ). -`®-'---------------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED -------------(-------------------------------------------- -- ---------------------------- ---------DATE ---------------------=---------------------- ADDITIONALCOMMENTS - ----------------------------------------------------------------------------------; ----•---------------- _ _ ----------------------------- __ _ ••---- __, . _ ----------- ------ --- ----- ------ --- - -- ------- - _ ----- -- --- - ----------------- - ______________ ________________ �R -\-*:K_ ___._________-__________.__ -f- __. _.____.., Final l.ns ection • P ��Y:�a ��--- SAN JOAQUIN LOCAL HEALTH DISTRICT [' E. H. 9 1-'68 Rev. 5M "��