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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7c/ Permit No. --------- --------- - ----- ------ (CompleteinTriplicate) y,16 7V Date issued --- ------------ This Permit Expires 1 Year From D. to Issued 'the work q _4I al Application is hereby made to the San Joaquin Local Coo DistO t for l permit t and existing Ruand lesand Regulations-:described. This application is made in�compliance,� ; � � ��. �-/ r 4 - CENSUS TRACT - � - !OB ADDRESSf LOCATIONS-pA- '� g - -�'- --� --- - ------- Phone ------------------------------------ ----------- Owner's ------- ----------------- F----` '. Owner's Name - sr-� ------�_Sl�--------'--- �-=-" - C�} = Address -p �.5� s ��--- Y � r ---------------- -------------- --- -- # /7 Phone --- ---- ----- Contractor's Name __(.._t-�-----��--- t- -C-�-�'`�''----��-'-`-- -"-•-�--- ---License # - \: G 1. i installation will serve: Residence E] Apartment House,] Commer pial : railer Caurt ;[] � Motel ❑Other �_�4:.,I— OOM y = i 'M e J' Number of living units:------------ Number of bedrooms - `—-----Gd,bage Grinder ------ Lot Size f—u Q---1 ^ - i Private Water Supply: Public System and name --------------------- -- = - - Character of soil to a-depth of 3 feet:rT Sand'[] Silt E41. Clay(E Pett[a Sandy Loam -0 Clay Loam r k c Hard an Adobe�� f yes,type ## p Fill aterial �_ �Y. (Plot plan, showing size of lot, locationlof system 1i reldtn to wells, buildings, etc mu -be placed on reverse side.) NEW INSTALLATION: (No septic tank or-seep pit permittedhif public sewer is available within 200 feet,) r r ` Size ----------- Liquid Depth .__, __.. PACKAGE TREATMENT { ] SEPTIC TANK[ r��,= f ti £ No. Compartments ---- -•-• �s " Material" - Ilk Capacity ._�`�-p.Q-- - - T:Yp? - --- r y'- - , j _ Fa�ndation Prop. Line ._ --•--- istance to nearest: VI?el��'�- �1� -;,------ -------- F ., rQ--------- Total Length ,-�QQ-------------- Len Length of eat line__ LEACHING LINE No. of Lines ----- --------- g « --- ------------•-------- 'D' Box ------------ Type Filter Material �� - V---- D,pth Filter Material ____-� - ---_--- t t 'Ifp, i�f � Pro er Line ------•---- Distance'}to;r ear est• Well _1�Q-- " ------ Foundati 1Q --- Rock Fred Yes ❑ No i[] Number . r l Depth Dame#er ---------------• V� SEEPAGE PIT j ] � p ---- -�------ ---�- } �` Water Table Depth f R Eck Size ________________________ - -_--Foundation ---------------•---- Prop. Line -------------------•-- � Distance to nearest: Well ______________________ ------------- i REPAIR/ADDITION(Prev. Sanitation Permjt# ________.-.- --- ----------I--------------- Date ------------------•-------- ------ Septic Tank (Specify Requirements) ------------------- -- ' F �" ------WA-R ► 00040_49n-0tj Disposal Field (Specify Requirements) _ -- "f K - _O� > �i �y___.7��OK ��•AFF(_c,.. ------AFT R------IN-ST-'!�-_RT- . = / R _ =- /hL-,Q11- -�+ IDraw exi - 1-- ting id required addi�t�on on reverse side) , I hereby certify that I have prep ethis application and that he,work will be done in accordance with San Joaquin `CdOnty'OrdiiiariEii,State Liiws,and-Rules an-d-Reg`ti4ations of"the`5an Joaquin Local�Health Dis'trict'Ho�iie ow„er or-li�en- sed agents 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 p as to becom object to Wgrkman's C pensation laws of California.” -- ----- ----------- Owner Signed -- ----- ----- - r - BY ------- - --- - ---- ------------------------------------ Title (if other than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ �i��0�----- -------------------------------- ---- -I-------------- DATE - l= if 3 ----- ---------------------------------------- ---------- --------------DAT BUILDING PERMIT ISSUED ---------------- - ------�------- ----1-- --------- ------- •-- ------•-- -------•----- ADDITIONAL COMMENTS ---------- ---- -- --------------------------------------- ------------------------------ a ----------- ----- -- r ----- - --- -- -- --- - ` - - ---- --..Date - -- --- Final Inspect b y k e. SAN JOAQUIN LOCAL HEALTH DISTRICT ( E. H. 9 1-'68 Rev. 5M