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FOR OFFICE USE:. APPLICATION FOR SANITATION PERMIT -----=----•- � Permit No...,�Q_'-- - -� (Complete in Triplicate) ......... _.... '----------------- --------v------------ S /t7• r _---- 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: r ._J-J�C '. --- �.Sl__(G'.9-/'_Ac"Oq`�.---------------- JOB ADDRESS/LOCATIO __ -, ,.---CENSUS TRACT ._.--..----_..-.-.--..-_ Owner's Name -+ 2_� -'------------_._ _,-- -_._ -------- --- - e �L�✓Address si; Contractor's Name.- �XAWAI -------------------------------- ----------- L -------- .... License �FzS.1-a2._ Phon:3_eS-.� Installation will serve: Residence tl9partment House Commercial ❑Trailer Court 0 Motel ❑ Other --------------------------------------'---- Number of living units:._ ------ Number of bedrooms -r-Z.---- .Garbage Grinder --- ---- Lot size ---- r Water Supply: Public System and name -------- ------------------------------- _------------ ---------------_---_--- 4 __...------ --Private 91--- Character L}/Character of soil to a depth of 3 feet: Sand &`Silt ❑ Clay ❑ Peat ❑ Sandy Loarri-0 ',Clay Loam ❑ Hardpan ❑ Adobe ❑" Filf Material _-.------- If yes, type ----------------------- (Plot ---... (Plot plan, showing size of lot, locc><,06 of system in relation to wells, buildings, etc. must be placed on reverse side.( W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( PACKAGE TREATMENT [ ] SEPTICjTANKI ] Size -------- ............__-..-.--_-.-_-___-- Liquid Depth .......................... Capacity . �- ------ ---- Type ....... ------------ Material--------------------- No. Compartments Distance toinepres�: Well ------------------------------------ Foundation ----- ---------------- Prop. Line __-................... LEACHING LINE [ ] No. of Line --------------------- Length of each line ------ --------------------- Total Length 'D' Box _t...j Type Filter Material .................... Depth Filter Material ._.__........ -_........ _............... Distance to'nearest: Well -------------- --------- Foun`daf Rio _-_.. ----------- Property Line ._-_--_- ............ PIT [ ] Depth __-----. Diameter ---- _ {Number __ i Rock Filled Yes ❑ No ❑ Water Table �e ]tr' Rock Size . Distance to n€a�est: Well ___. ..._.-.. 1 ----------- Foundation I -------------- ---_- Prop. Line ...................... REPAIR/ADDITION (Prev. Sanitation Pe' mit # ----- _____-_----.__- Date ........... r_________________.--) Septic Tank (Specify Requirements)-;-----....... ....................... ---••-------.._..-------------- D�isPosal Field (Specify Requirements). /.25_T -- -- h�- ✓>Y /fI�'t4ell ------- L'- h:E�......... 3E---- _ _ (Draw existing and required addition on reverse side)' 1 hereby certify that I have preparedithis application and that the work will be done in accordance with San Joaquin ` County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the folloyring: "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_.. _.... ------------------->---------- ------------- -------_------ Owner Title �(il i(!%//1 :. 2zk�A � '-- ------ --- By <.. - - = - - — - (f other than own (` FOR DEPARTMENT USE ONLY te�--t�--� �, APPLICATION ACCEPTED BY -----1- z - -- - - - - DATE .. � _ � .. %C -..-.. BUILDING PERMIT ISSUED ------- _-.--__]-------- ...................... DATE .---.__.-_-- ADDITIONAL COMMEr.. -- -- --- -------------- --- -- - ----- --------------------------------------------------------^ ------------------------------------ ----- - ---- --J ::::- -- ----- -------- -- -f ..- .. `Fj ` ---=KTP-!✓ �- -- - Date ... - t-..1 Final Inspe SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M