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FOR OFFICE USE: ` APPLICATION FOR SANITATION PE IT ........_.............. . t "1 Permit No. ..7 ��.ct1 S pler 4111. (Complete in Triplicate) ..........................�.<. i ............... ........ This Permit Expires 1 Year From Dat*Issued Date Issued ..��-.2.._.7r 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 c/o in compliance with County Ordin rias No. 549 and existing Rules and Regulations: JOB ADDRfSS/LOCATION ... .L .....,��AA .....1�1.................................CENSUS TRACT ......�......�0•.. Owner's Name ........... -( _ - ............ ...... ��. Ph 3 -)f l.. E� Ic fsK 'lone . -..................- Address ... ....... .. .....-.. - -- � � City ....... . ...n. ./.... . .. Contractor's Name --- -f..sl:..........---...........License!F ,.Z.:3.y . Phone -- p-6--"'..1.--. Installation will serve: $esidence;(Apariment House Commercial oTrailer Court Motel ❑Other............................................ Number of living units:_ t ur ber of bedrooms .....- -... g ---- ----� ,fes Garbo a Grinder ............ Lot Size ..--..�C-4�._.._._.. Water Supply: Public System and name ............................._- .-.--....................._.»......................................Private QX Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay Q Peat 0 Sandy Loam Q Clay Loam ❑ Hardpan Q 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-. iNo ptic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] EPTIC TANK ] Size................................................ Liquid Depth .-...........•......... Capactty ..._ .- _.__ Type .................... Material_---------.......... No. Compartments ...... Distance to nearest: Well ..... ..............................Foundation -------- Prop. Line ..._.»..._ »»_. LEACHING LINE ( ] No. of Lines tof each line....................._ ... Total Length 14-Distance fdl<nedreype Filter Material. ....................Depth Filter Material .-_..._............................_..... t...... Foundation ....... Property Property Line ........................ SEEPAGE PIT [ j Depth ------------ "'r Number .......- Rods Filled Yes O No (I 1 Water Table D P. . .................. .. Distan'&iitb n}t At: Well ........................................Foundation ........._..-..---. Prop. Line --------••--.-•-•-•-- Sonit REPAIR/ADDITION inkgtim .•...------- •-- •-.- Date ...._..__........-_-........... ts ----- Septic TaSpefyRguiri tv ............_.............•.....•••... i -- . . � . .. ....... .40- Disposal Fiel (Specify Re u . ........................................................... ... ..... - -- 4(------ . x a '----- . ....... --_--------- ----------------_- ............................. ...... -- --- (Draw existing and required addition on revs a 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 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 ___ _ ---------- - - - -- Owner �n, By -- - .... . _'_.. . -------_---------------------- --------- - Title ........ II ther n owner) F DEPARTMENT USE ONLY ,/ APPLICATION ACCEPTED BY ...Gdl. -----------------_-------- -- --------- DATE ._.T:7 ,775.-,,:,.. BUILDING PERMIT ISSUED ---_---.---------..._ . ._...1 --. DATE ..... ADDITIONAL COMMENTS ----- ---------- 1 - - - -- - ... - -._.. - ... ....... ................ . . _......_.. ------------ ---- -------- ------ ----- . ............... ............-._ -....... ------- ...�'.'... - .. .... ..... ..... . ........ - -- - ......-- - --- _..................-... _.. ... - -....-----.. Final Inspection by: ...... - -- ` - -- . . ........ -- . - .. ..:..------------------ - .Date .... c./. <�. . - ...... EH 13 2L: 1-68 Rev. 5M SAN JOAQUIN LOCAL HE LTH DISTRICT 8/711 3M `