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f • y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT y Permit No. -_ `.3....!_ .........................•--•......^.,...___..::...:__ (complete in Triplicate) ........ -• Date Issued 73 This is Permit xpires 1 Year From not issued Application is hereby mode to the San Joaquin Local Health District fora 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/LOCgION -fXJ •-. _-.... 4 -- .............CENSUoseTRA C7 -_--_-......_..,__._.. S 7� Owner's Name -.. - .............. f ----_----...--------...- Address --------�JT�-�Z....._,5:_....L..A.WF.�-. .!��,..._........ City _ - --------- _ - --- Confractor's Name -....QidL�.�—f..Z.--------.,v_i-..... : ---'-----'-------.. License# ----------------. Phone .......------------ Installation will serve: Residence 'Apartment Housefl Commercial♦]Trailer Court i❑ Motel ❑Other ._........------ ------- J g i. . Lot Size .iCIZb� .... Number of living units:....r...... Number of bedrooms _..._.Garbage Grinde� Water Supply: Public System and name .......... .............. _-•---...... --------------- ----...................._....-Privat Character of soil to a depth of 3 feet: Sand ❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom - Hardpan Adobe❑ Fill Material ...... ----- It yes,type ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed n reverse side.) r NEW INSTALLATION:)` No liepfic tank or seepage pit permitted if public sewer is avai bie within 20Q feet.) .... 'Liquid Depth .............. --------— PACKAGE TREATMENT"[ ] SEPTIC TANK(t] Sae_..------------------ --- � q P .. Material.._ No. Compartments ..........__. Capacity ._.... .. YPe --- _ . F� Distance to nearest ell - .---- .........._Foundation _ Prop. Line ----,----( ... � Total Length ra LEACHING LINE [�1,. Na. of Linea. _....' ._ Length of each Lne.:� g --•' "" "`1/ • D• Box . Type {Iter Material .... ....Depth Filter otenal ------ -•Distance to nearest: W 11 _- Foundation ._.. .r�lProperty Line --- •-• kA SEEPAGE PIT [ ] Depth .................._ Di meter Number Rock Filled Yes ❑ No Q Water Table-Depth - ....Rock Size ....+_ .........._... Distance to nearest: W . ..... _-.-- ...Foundation Prop. Line .... Date - - REPAIR/ADDI710N(Prev. Sanitation Permit# q1 3 Septic Tank {Specify Requirements] .- -� - ' - Disposal Field (Specify Requirements) ----Q/S7- 115.QX - -- . E4C� � - (Draw existing and required addition on reverse sidel. - - I hereby certify that I have prepared this application.and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and. Rules and Regulations of the San Joaquin local Health District. Home owner or licen- sed age signature certifies the f wing: "•I cerci tat in he a the work for which this permit is issued, I shall not employ any person in such manner as ro be o e bjec to orkm s Compensat on Taws of California." Signed - - - -- ...._....._.---_- ------ Owner !, -. .----'----- By .--`_... - --------'--...-'-------'- _..-...-....'.---:_-.--..».._..:--- �..- -!�'1-- . Title - - . -- .......-----------_...---..-- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -------f- '-R..rCJ.c....................------- ..........—...... - DATE .., <:. ..._.... - ....- ----------DATE---..--....._.._..._----- -._. BUILDING PERMIT ISSUED ADDITIONAL COMMENTS -- _. .... ...91 - Date T ..._. �. 1 v 1 Final Inspe i. .. --- -- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M