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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. �f-6 76 ----------------------------------------------- _._-__-.----.---. (Complete in Triplicate) ./ -- ----- - - --------------- Date Issued ----- ------- This Permit Expires 1 Year From 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: :: JOB ADDRESS/LOCATION .._._L_4ZO:?--�2-----�----.----. 1-fl-r LCT`--_--_----_.--_.__._ -- TRACT ._ Owner's Name . . �5 L11 k) ! 1>------------ Q�-� - =h'r �L!-I .I') ��f�:-�-- Phone L Address -------- r ` '- -----------`- �\_!l-)_HC7/y............ City �>C✓ ).L�7f� __ Contractor's Name -----t-'-v- �1�- -1- -------------------------------------------------------License # ------------------ ----- Phone ---------------------------- Installation will serve: Residence E] e Apartment House Commercial ❑Trailer Court L Motel ❑Other __61FIRt)&fi-.-._f C:`ii G CJI" Number of living units:.._.--._... Number of bedrooms }:r._:--_-Garbage Grinder r---:------ Lot Size -.-_25- .e--:...... LWater Supply: Public System and name ------------------------------------------------------------------- -------------------Private M L Character of soil to a depth of 3 feet: Sand]] Silt❑ Clay ❑ Peat❑ �Sandy Loam 0 Clay Loam 1l—. Hardpan ❑ Adobe D Fill Material --- If yes,type ----------------------- L (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 TREATMENT [ ] SEPTIC TANK Jq—_ Size------- _X- �4-. �... _>.------_--- Liquid Depth .-. —,----- Capacity ----�__ _.- Type �_-.-::ifs._. Material---- l:....-.! No. Compartments ..-.--__---�_- G Distance to nearest: Well . ---------- --------Foundation ----- ---- f)------- Prop. Line ------- LEACHING _--_LEACHING LINE [ ] No. of Lines ------------------------ Length of each line.-------------------------- Total Length ---------------._.___--- t� 'D' Box ------------ Type Filter Material -_-------. _-----Depth Filter Material -------------------------------------------- - \ I Distance to nearest: Well .......... Foundation ---------.--I'd----- Property lin® ...---------------....... 6. SEEPAGE PIT t<j Depth ._J.0---------.. Diameter Number ---- ---------__ Rock Filled Yes 13---No Q Water Table Depth ----------------------------------------------Rock Size ------------------------------- L. Distance to nearest: Well ---------------- ------------------.....Foundation -------- ----------- Prop. Line .._.....-._._.--.- REPAIR/ADDITION(Prev. Sanitation Permit# -.-.-.--_.---._.---___- . Date ..................................I LSeptic Tank (Specify Requirements) ----- ------------------------ -- -------- --- Disposal Field (Specify Requirements) ------------------------------------------------------------- ------------- L -- --- ----- ---------------------------------------- ------------------------------------------------------------------------------- - ------------------------------------- - - -------------------------------- - ------------- ----------- - -- ---------------------------------....... (Draw existing and required addition on reverse side) L 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 Las to becoyoe subject toX,orkmans Compensa ' n laws of California." Signed .-*./-E-1`fl': -�(----- -/(-'-- - .�T -�-�--�-=---=---------------- Owner / ' - ------------- L By -- ----------------.... _---------------------------------------------------- ----- ..- Title ------------------- --------------- (If other than owner) I dfv FOR DEPA ENT USE ONLY ( APPLICATION ACCEPTED BY- — t- - -- - - - ------ --------------- DATE { t L - BUILDING PERMIT ISSUED ..----- - - --- --------- ----------- -----DATE ------------------- --------- ADDITIONAL COMMENTS _.----? ---_ 1.41-1=`-----LLLt_-___.11 _-------� . . /).er-----AOR-------�)1lsL/.1f -------- OL�k -- ----- ...... - - - - - ... L 1 =11tl.r.fa {QA �VZ1-r - N1 - _ - Date -- - -n - ` t - ------------------ ._. ..: - / J --- - Final Inspection by: _ __ X47.--- --_- -- r -- -- ----- -- LSAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M