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FOR OFFICE USE: ..PPLICATION FOR SANITATION PER' ' _... . -.. _..... ------------------ - Triplicate) 1 Permit No. (Complete in Trip icate --------------------------------------------- . ---lo!.� • ____--_- This Permit Expires 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 ismadein compliance With Cdugty Ordinance No 549 and existing Rules and Regulations: -0 JOB ADDRESS/LOCATION _.4/00-......, -----1"400461---Ale- -------- -------CENSUS TRACT - 1---- yy� ` J Owner's Name �/jj:-uc.cS ----- - - - Phone - -- Address ._ 2 ,lam- 4A EC1�-- ��j-- - ll�tjO� - ----------- --------------.....city L't- - . ..--- ---- ---- ...------------------------------------------- %e - - --- --- ----- 47 Contrador's Name --K--- --------ur-z/ /'e------------------------------License #. yc / _. Phone p/ .-- -- Installation will serve: Residence C9 ApartmentHouse❑-Commercial❑Trailer Court ❑ Motel []Other ,---. - -`---- �/j A Number of living units -.---- Number of bedrooms 2 __Garbage Grinder -----_ 401---.- Lot kze' 2-e—oO ---e--------- Water Supply: Public System and name ----------------------------------- ------------'--`----------------- .Private Qg Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑A ' Sandy Loam Clay Loam ❑ .Hardpan ❑ Adobe 0 Fill Material NQ-r-- Ifyps,type ..-_.---_---_.._-__-.- (Plot plan, showing size of lot, location of system in relatii to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permi ed if pu lic sewer is available thin 200 feet,) C PACKAGE TREATMENT [ ] SEPTIC TANK] ] Sie-_ .`f'' r-� -- a_,,�-------.--- L quid Depth -- -?---......---. n Capacity 1_2-vb__ Type /' _-.--CO.-- _ Material.(ZLn o. ompartments -2............. Distance to nearest: Well Z5-CO-0 -------.-_-....Foundation -.--/.O-/ ...:- Prop. Line .._ .:........ LEACHING LINE [ ] No. of Lines ___ '_-___._ Length of, each line--- To I Leligth .-�. ------ ...-- Q 'D' Box ------------ Type Filter Material 1216.............._-.Depth Filter Material .l-___.--..----.---._........-..-•---- Distance to nearest: Well .._s�d-- --_--- Foundation _f-4. /-_._- roperty Line ..75....._........... - ---- - SEEPAGE PIT [ ] Depth -------------------- Diameter ---=-- --------- Number --------- - -- R ck Filled Yes ❑ No Water Table Depth ------------------------ -----------_--------Rock Size ----------- - -----------` Distance to nearest: Well --------------- _.... ............._FoundatioR--------- _ - Prop. Line ---------_........._ REPAIR/ADDITION(Prev. Sanitation Permit# ----_--------_---- - --------;---------- Date ._.-----_--- ..... -- -.) Septic Tank ISpeci Requirements) --- ---_-------------- ;} - -- - - - Disposal Field (Specify Requirements) ..WPLAC_9�...._.44 ----_-C 'i _-%_Nr -.----wrr ---.-.-1.7-0 7� DgRaO1V------cpamr`---PA�Fig-B 2 .=, -A -.. wt L F�R_C .- LlS - ---- - -- - ----- -,(D'raw 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 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 as to become subject to Workman's Compensation laws of California. Signed - ---------------- ---1--- -- Owner - - By .-_---- ----- - - - --------------------- Title; ----------------------....- .. - (if other than owner) i F61F DEPAtt`JfdENT USE ONLY APPLICATION ACCEPTED BY___-_y- �_ _ �' zS=---7a---- BUILDING PERMIT ISSUED ---- - _ 4 ----- --- - -=- ------- -------------------- ----------------------. DATE --------J-- - - - ------------- ----------- -- - ---- - - -- -.DATE -- - ----- ------- ---- -- - ADDITIONALCOMMENTS - - ------------- -- --------- --- --__---- -------I----------------------_------I—----------- -- - - -- -- - - -- ------------- ---------------- - -- - - -- ----- - - - - - -- ------------------- ------- ------------ ------- V -- t Final InspeIi - - - - - - - - -Date - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M