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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. .� .s..3.... _...,.- ._...................................... ` • ' Date Issued �,.. ...._, ... ,� This Permit Expires 1 Year From Date Issued 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 No. 549 and existing Rules and Regulations.. JOB ADDRESS/LO ON ..�4�. .Z_ ............(E;ci..... ............................................._ CENSUS TRACT .......................... _- 7 ....... ,Owner's Namey.t.5......K.-----• ... .. 1'1........ ..___V Phone ...._.... Address ..... ... .4S-.:.. . G.C. d.y1.e.. . ............. City ...> k -....... ?......_.. ... .... ... . .. . . .... Contractor's Name ...GLIS.CA S.f�c�ia I.&� � . ._.....License #a��►�...�y..._. Phone ..i�.��._....�{.�._.__. Installation will serve: RI!idence6?Apartment House Commerliajl+OT61,1er Court-0 ' Mot e1 O Other .;.:__................ . d / ✓ f i Number of living units: J. Number of bedrooms ..?it......Garbage Grin er�......... of Size .Q.S,! 'C@�................... Water SupplPublic System and name . .. .............................................. Private Character of soil to a depth of 3 feet: -sand❑ Silt[D Clay'(g Peat Sandy loam ❑ Cloy l m j] HordpL❑ Adobe ❑ Fill Material . _.._.... if yes,type .......... ...... (Plot plan, showing size of lot, location Jf system in relation to wells, bildings, etc. must be placed on reverse side.) I NEW INSTALLATION: (No septic tank torfseepage pit permitted if public S11weris available within 200 feet,) ,. PACKAGE TREATMENT j ] SEPTiG TANOT I Size _ ...�:.L�. �.._. aL.. :.Iv'Liquid Depth .. .... �.. _. Capacity zUU I . Type,� Material. �.Y�rte±�T._. l No. Compartments ...................... Distance to nearest: Weft - dC?`.J"................Fjr oundation ../A....._... ..- Prop. line .-rs �....__.._. LEACHING LINE No. of lines Length of each line _1 S Tota Len th 17.Q D' Box _ Type Filter Moteria('C Q ..DepthFilter Material Ips.........`......*.....__..........�._W i _ I '�► Distance to nearest.,Well ...� . ._...... Foundatio .:........... Property Line .lsa ...............t SEEPAGE PIT ( J Depth ./ € Diameter Z'''�._�Z.. Number .2 ......._.�.._�� Rodik Filled Yes No ❑ Water Table Depth /0U............................. .....Rock Size•... ....._....!......... . ._. ...........Fo rV Prop. Line _(0.............. .hR Distance to nearest: Well .... �- DatUndation ri t �Q` REPAIR/ADDiTION(Prev. Son itotion-Permit# .._-_... ---_--_......___._...... e . It..... .�... .._) Septic Tank {Specify Requirements) .... .. ...... ...................... Disposal Field (Specify Re virements} --_-_----•-••-..... --->--_._....... ......._... ---.--r......... - ........ ----- -•--...�........................................... ........................ ........... ............... ..-�`'"' .... -.. ............-- --- - f(Drci``,existing and required addition on leverse side) f I hereby certify that I have predared this application and that the work ili be done in accordance with San Joaquin County Ordinances, State Laws,Fand�Rulesiand Regulations-of the San Joaquin Local Hsiotth District. Home owner or licsn- sed agents signature certifies the-foll*4Ang: t ) "i certify that in the performoncet of the work for which thii4ermit is issued, I shot not employ any person in such manner as to become subiect o Wo kmon's mpensation laws of California." ............................ .... Owner Signed ��'" ...... _..... .__. jt` By ._ j . ..... ......... ........... .... ... ._....................-..... .._ ._ Title . (If other than 6 nerl' � ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY , ....._....... �. DATE .. �•' •--• ••-- BUILDlNGPERMIT ISSUED .... .............--- ...._..._ ................................ ... ......... .1..DATE .. .........................._............. ADDITIONAL COMMENTS ........................... --------------------------------------------------------- . .......................1......... ...... ......................................................... •....._..._.......•• ..................I...........----- r_ -- ..........I............................. ... .......... . ................ ...... _ �. :�-.- ............. i_... . ...................... ............. ... _ .._ Final Inspection by: .. t ............Date ._.. .. % . .._ ' .... SAN J AQUIN LOCA HEALTH DISTRICT ONO, 13 24 -7/71 'AV E. H. 1-'68 Rev, 5M _��___