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•v,. JLi APPLICATION FOR SANITATION PFQMIT Permit 7 3� (Complete In Triplicate) n J 0 r4(? 7 Issued ............................. ................._......... This Date Permit Expires 1 Your From Day Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application is made In compliance with County Ordinance No..49 and existing Rules and Regulotionss G 9 So f h f'1..... ' cENsus TRAa . . . ...... .......- JOB ADDRESS/L ON . ....._...-- --_-__.__.....--- �.--- Owner's No �. "!.W 2 CIA n4 . . ... ... one Y-.` 0 Q ---•--- -- Address . 3 73.,-/y.S.q-�.. ..., . rl�-Z. . styo a • - _- Contractor's Name _...iY-f ----. . . .................-----.-.License # .._. ----- Phone ------- --------•-•---- Installation will serve: Residence M Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other .. - - -- -------------- ............. d n Number of living units:..__. _ Number of bedrooms ..-2-.-.Garbage Grinder -----...._. Lot Size ---�.n.c'_-..-_------- - Water Supply: Public System and name _.-- -t'_ - ..................••--•--------....---------_.--•---------------------------Private ❑ Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam Q day Loam Q Hardpan ❑ Adobe W Fill Material ------ ..... If yes, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) 1 PACKAGE TREATMENT [ ] SEPTIC TANK ] Size_........ ......................... .......... Liquid Depth ---------••------------- Capacitylvad f r LType .........�..�... . Material_C.01.!Tifse�No. 5ompartmonts .... Distance to nearest: Well ...GE2cr. ........Foundation ...,LC?............. Prop. Line __4 ..._ ---------- - LEACHING LINE [ ] No. of Lines.. .. n f -------._--- Length of/�ea�ch� Ilne._.......{�. ......._. Total Length -. .w..._._._.. 'D' Box .....�__ Type Filter Material AP._&AC. Depth Filter aterial ...._-4?V....................I.... Distance to nearest: Well .le6l.......... Foundation -Ze................ Property Line --- ............. SEEPAGE PIT [ [ Depth .................... Diameter --------- ...... Number ............................ Rock Filled Yes ❑ No Q Water Table Depth -------------- .............-------------------Rock Size ................... ............ Distance to nearest: Well .... .........Foundation .................... Prop. Line .........-........... REPAIR/ADDITION(Prev. Sanitation Permit# ------------- Date ..................................I SepticTank (Specify Requirements) --------- .... ....... ................................................. . ..........•-.... ............. ..................... Disposal Field (Specify Requirements) --------...-...................................................................... --------- -------- -... --- - -- - - - ----------- --------- ------------ ----------------------------- ---------------------......----.......... ._ - ---------------------------------------------------------------_ .._ .............................. (Draw existing and required addition on reverse side) I hereby certify that I 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 Ilcen- sed agents signature certifies the following: "I certify that in the performance oft work for which this permit is Issued, 1 shall not employ any person In such manner as to becoa ubitlto W kman's meens :on laws of California." Signe? iN /i/� - Owner - - - ---- ------------------ By . ---- --- ------ . Title ... . (If other than owner) FO EP � ENT USE ONLY -- — - APPLICATION ACCEPTED BY e 9 _.- - ----------- DATE BUILDING PERMIT ISSUED' / . ............DATE . ADDITIONAL COMMENTS . i. _�w.R.�c �,�.,«,.�a�,.- �-� ... ...... Final Inspection by. ..- .... -. .. .... Dat / ' EH 13 24 1-66 ikv. 5?1 �d;tN ,;0AQUiN LOCAL HEALTH DISTRICT 8/7h 3M