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FOR OFFICE USE: / .� APPLICATION FOR SANITATION PERN4T p� . J.- -La -�---j-= :..------ - Permit No. .�s. � v (Complete in Triplicate) �✓ '/ .._...____-----.-----_- ------............... This Permit Expires 1 Year From Date Issued Date Issued �1Y.91-6� 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 e ' ing Ru[es_�ad Regulations: JOB ADDRESS/LOCATION ._/12_.Q.._.r,Kz____— ----.__.._CENSUS TRACT ...............-------_._ Owners Name -------- .......4nN�----------- - --•----------------------------------- Phone Address -_---------- ... ..9L ---- 45 SD------- y ------- 4 O.V........ ------ _ -------•--- Contractors Name _____IOQU77_ 4NY --------dJ License # B_.-3 S 3-ZPhone 3_.. +k Installation will serve: Residence❑Apartment House Commercial ❑Trailer Court j] Mote[ ❑Other -----• --, ------!/_/0 `71_oc - Poe e1601 Number of living units:------------ Number of bedrooms .----._-._.Garbage Grinder ............ Lot Size ..---.--- Water Supply: Public System and name --------------------------------------------.... .....---------------------------------------------------Privatg Character of soil to a depth of 3 feet: Sand'❑ Silt Clay ❑ Peat E] . ` Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe' Fill Material .._ - If yes,Type ------------ --------------- \ (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,) PACKAGE TREATMENT94'Z � f . [ ] SEPTIC ] Size______-�O.oplz - '.,--,�"--f`�-- Liquid Depth ___.1-._---._..,.-.-- Capacity ...1Qo-D_---. Type ----- No. Compartments ....4--------------- / �(Q __......Foundation _@-J!_'!^L��-- Prop. Line .---- -.� >� Distance to nearest: Welln.t_____.___ _ --- LEACHING LINE [ ] No. of Lines ------FL___......_.. Length of each line__.lA._o_._.._.__.._.__ Total Length __J1.QR............ 'D' Box)P.,-G..___. Type Filter Material 5r�`7.-fl-641kopth Filter Material ._.----It-.//.--._._---------- ------- Distance to nearest: Well .Q_Y✓-- _� Foundation _A-Yr✓___Lo�_.. Property Line ___i_aa.::------------- SEEPAGE PIT [ ] Depth 95R........... Diame{tter .AL.-_..._.. Number ...__.-5'._-_------------ Rock Filled Yes ® No D Water Table Depth ... '.............................Rock Size ------- yi...----.--_.. Distance To nearest: Well ------ . r-_------Foundation �Prop. Line ...Lm=........ REPAIR/ADDITION(Prev. Sanitation Permit# _.__-............-------------------------- Date _.------------------._.._.-------- Septic _____-_Se tic Tank (Specify Requirements) 16120 _..• --------------- ----------------------- Disposal Field (Specify Requirements) -------....-r. e._ f.L._-.___-_--.--_-_________________.___ - -- �. - ------- ----------- -- -- ---------------------- - - - - - ---------------------------------------------- JDrow existing and required addition on reverse side) 1 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 followi'nt: "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 -------- / LJ1/j_ ��---C Ae n----- --------------------- Owner By ._.... ----- moi" .------------- _ Title _.... '1 - ...................... ......if-other than owner) DEPARTMENT USE ONLY LL APPLICATION ACCEPTED BY - - . . ... . --------------------------------------- ------------ DATE = `TT ---- MIT IS ED BUILDING PERMIT ISSUED - - ------ -------- ------------------_--- DATE - ADDITIONAL COMMENTS .�j/ -- - - - Mr - �f-'717 t dk�f9-�>7 - --- -------- --------------------------------------------- - -- ------------eJAQUV4 ---------------------------------------------------- ------------------------------------------------- ------ ------------------ ------ --------- ---- Final Inspection b - - ------ - - -- - ,r .fi y: - - ----------------- --- - ----- -------.Date j --- --- ---- SANLOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M