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I r FOR OFFICE USE: p APPLICAT!nN FOR SANITATION PERMIT 00 _ . Q (Cornplete in Triplicatel Permit No. .50- This Permit Expires 1 Year From Date issued Date Issu. ./J:/a?C'76 Application is hereby made to the San Joaouin Local Health District for a permit to construct and install the work herein described. This application is made in corn; 'lone with County Ordinance No. 549 and existing Rules and Regulations: 108 ADDRESS/LOCATION .. ....... ....... .... .....CENSUS TRACT ................ _ Owner's Name .... . ... .. .. �. Phone .1 /.�.�3 ... . _. ...... Address ......... .......... . .. / ....... �y - ..................... .........City ... _ . ._ . ..... .............----------------...... Contractor's Name .. ._ _:..:CG-�?' �..............Llcense tR 1Q'd. �l..... Phone Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel❑Other............................ ............... ` Number of living units:... /. Number of bedrooms .-......Garbage Grinder .....✓....._ lot Size ...�.. A--.--••.•.--- Water Supply: Public System oma name . ........ ........................................._..............._........._....................._....__..Private` Character of soil to a depth of 3 fret: Sand 0 Silt❑ Cloy ©' Peat 0 Sandy Loom ❑ Clay Loam ❑ r Hardpan❑ Adobe Fill Materia) If yes type Y, .ti„iY w 3 �qy�,,• ...... .... ... * �3'(Plat plan, showing siz,� of lo', location of system,�Ihjrelatianwells building s`1etc imust bii'placed on reverse side.) Ni:1N INSTALLATION: INc septic tank or seepage pit permitted if public sewer is available within 200 feeM 0: PACKAGE TREATMENT [ ] SEPTIC TANKV9.')< , .� ............... Liquid Depth ...5 ........... Tye MiCapocity ... aterarNo. Compartments ------ x Distance to nearest: Well ..../00....' ...............Foundation ....ZS........... Prop.Line...................... LEACHING LINE No. of Lines .. .... .. .; ��.............. length of line........��...._......_ Total Length .....*;L-10 'D' Box �. Type Fitter Material . � Depth: Filter Material ....._./..F_... Distance to nearest: Well /UO.'.+.......... Foundation s.� fProparty Line ........................ SEEPAGE PIT �Q Depth �sr,.�.,, Diameter ..�p...... Number .......2 ........... Rock Filled Yes No ❑ I ` Water )able Depth s ........................Rock Size ot"4z, J Distance to nearest: Well �. .f......................... Foundation 1 ..,f'_.. Prop. Line ...._...._........._.. t REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..J.......... ...................I ! SepticTank (Specify Re'uirements) ............................................................................................................................................ Disposal Field (Specify Requirements) .. ............................................ ...................._........... .." .. .A........ .............................................-------.........._.._... ............................. ... ..................................... .......-.............. ..-.-..._._..... (Draw existing and reqoired-addition on reverse side) I hereby certify that I have prepared this application and that the work wlli be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne owner or lice". i sed agents signature certifies the following: ' "I certify that In the performance of the work for which this permit Is Issued, I shall'hef employ any person In such manner as to become subject to Workman's Compensatlon laws of-California." r Signed ............... Owner _ a , 'i, itle .- • $y .............. .. ............;.... O e.r t oV.awl F R DEPARTMENT_ USE ONLY .. APPLICATION ACCEPTED BY �.�.�. ../. . ............ . ............ .............. DATE ...� ./.�.-. �........... BUILDING PERMIT ISSUED ............................................................. MATE .......... _........ ... ADDITIONAL COMMENTS /- EJ ., ......... -. L. .....� r��..:::: 9-. f�? ::::".....: :::...... . .......... ........ ...... ............ .... ..... . ....... . Final Inspection by:' f �� ! �i �; . ...... .... ... ........... .............. ............................ . .gate SAN JOAOUIN LOCAL HEALTH DISTRICT E. H. 9 1-'f B Rev. SM - — i``