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'PLICATION FOR SANITATION PEf err ------ (Complete In Triplicate) Permit No. ..... ....... ............................................. -- - .............................. This Permit Ex 1 Year From Date Issued 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 compliaannce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . . .p .J5 . -! .. � jn. de�. C K CENSUS TRACT 66 Owner's Name ./7I QG.T./��..G/r;,5� ... .....-- . . ... ......Phone . � 3. Q.3.... O,ddress 0-3 s.:S'7 /V, .�n c�'din.!�C-��......_ ... .._.............. City -..N,l � _... ... .. ontractor's Name ... -L�—.u`_.,�.:�<i„L:�N._, �e vt.al.�-C.- . .....................License # 2.ST..'dS!9... Phone ..$Y/..Y...:.0�:..4-.Ce - Installation will serve: Residence [Apartment House t] Commercial ❑Trailer Court fl _ Motel ❑Other .....-.. ...-. ........................... Number of living units:-. ....- Number of bedrooms .. .....Garbage Grinder . .. Lot Size ..ffCls ................. Nater Supply: Public System and name ............. . .......Private 4haracter of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ if yes, type ............... ............ fLA? blot' plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r0. NEW INSTALLATION: (No septic tank or seepage pit permitted If�ubllc sewer is available within 200 feet,)♦/ 'ACKAGE TREATMENT [ J SEPTIC TANK j ] Size.-. � ........... ......... // l \1 ,i�� . ......._ Liquid Depth --f ., .............. v _ Capacity .��..�.?.o _. -,Type !` �.C $7.`Material L�!:!rrtY:TG No. Compartments �I j P✓ 2r r P 7 ..:.J�.....- �� Distance to nearest: Well ..,�.............................Foundation ..rJ.d.............. Prop. Line .-�.Q.�.......-.. ING LINE [ ] No. of Lines l ... Length of each line.. ... . Total Length ...121-1.1................ D' Box ... .. Type Filter Material .....y-. ..........Depth Filter Material ... .................................. - Distance to nearest: Well ��t... ..... Foundation -h`/.'f_.......-.. Property Line .,� .f ......... . ...�sisr.eLier ..._.__._.............. -I- ............................-------.... ...-...�n..ae D II ...... - ---- i4rsrsldien ......... ..._.....mss`....... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................ ) Septic Tank (Specify Requirements) ._................. .. -- ............ _ . - . - Disposal Field (Specify Requirements) --- - .. e �r- ...._......�.........,. ...... ......................................................... _...- .....- �.......-..'.. P .f.a4_.. ....... .... .. .............. .... - ........_....._.................................. ..........---...-....... (Draw existing and required addition on reverse side) hereby certify that 1 have prepared this application and that the work will be done In accordance with Soni ounty 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 performance of the work for which this permit is issued, I shall not employ any person in such manner to become u lett to Workman's Compensation laws of California," [I Signed / �i/Gi(iw45 Owner - _ _...-_ __.. . .. ............. Title __.. (If other than owner) FOR DEPARTMENT USE ONLY PPLICATION ACCEPTED BY ..` " -t - --- ... DATE ��// e,JILDING PERMIT ISSUED / ..... . - _ DATE ADDITIONAL COMMENTS .PC- 'T . a ::{ '" . ..... ...... .. ... _ _ - ............. _ ...._ . ► _. .- /l / /,- / �l Final Inspection by � .._..... - ..__. Date /. S 13 2b 1-60 1 5� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7l1 jM