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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.79-'�1/59' (Complete in Triplicate) ..... ........----- ---- P _.-.-..... Date lssued��".��••_.'7`2 � 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/LOCAT ONS!-./G-10-1-" "5-- SVT-' �__F/F R.D.,-1-1- ------ --CENSUS TRACT ._.-�'� ----- Owner's Name �..L - (t�LfE�hl_N- - -L�one Address -------f.11d =/G� ----� . SU �-L•_' /--?--'� City 7' + Contractor's Name ..._....f�LS4 4....&)..Cly _License # :----- Phone Installation will serve: Residence O-Al5artment House❑ Commercial:❑Trailer Court ❑ Motel El Other .... ---- ---------- ------- •---- ----- Number of living units: ---.. Number of bedrooms ..�_-_--Garbage Grinder �S Lot Size ��R�-A�.�-------•----- Water Supply: Public System and name _________________..-. Private ❑ Character of soil to a deptb of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat Sand Loam ClayLoam e --•------------------------- Hardpan le ❑ Fill Material -..._ ___ If yes,typ(Plot plan, showing size�r'of lot, location of systemelation to wells, buildings, etc. m stbeplaced on reverse side.) NEW INSTALLATION: ,No septic tank or seepageermined if public sewer is avail within 200 feet,) rj SEPTIC TAMC Size Liquid Depth ------- ------------------ PACKAGE TREATMENT r(t] ] Ca acit Type --------------- Material--------------------. No Compa�'tments ---------. ---------- PY ----------------- + y. Distance to nearest: Well --------------------Foundation ....... .......... P,rob. Line ----- ........... LINE [ ] No. of Lines .---------- ------ ngth of each line._------"_:------.-.----•" ota) Length --------- .................. -----De -----• --•------. `�D' 'Box --------- - Type Filter M tenial -------------- Depth Filter Mat ial t..._____.____.._�___-- I Distance to nearest: Well _.__.. . ___._.._ Foundation -------------- --------- _ Property. -Line ________________________ SEEPAGE PIT [ ] Depth --------- - Diamet ---- ---.-Number--__-_----f--------------• Rock Filled Yes ❑ No 1 .:Rock Size ---- -------- Water.,Table Depth Distance to nearest: We11 '.-----•---_----_Foundation ------------ -- Prop.ro i L ) REPAIR/ADD {Preva 5anitation_Permit# - �T - Septic Tank (Specify Requir ments) ---------- --...5—- ------------ Disposal Field {Specify Requirements) x.�_� 1d ----- - -- - t ^ IN- 3✓ WCAT ')(Draw existing and required addition on reverse side) -that 1 have prepared this application and that the work will be done• in accordance with San Joaquin I hereby certify p P County Ordinances, State Laws, and Rules and Regulations of the San locquin Local Health District. Home owner or licen- sed-`agents si _ature certifies the'foll 'wing: I t. "I�certify th in the p Jrman �f •t a work for which this permit is issued, I,shall not employ any'person in such manner s as to beco a subject or s mpensation laws of California." i c _ ` Owner, }Sig d :�- - -------- i - t-R-® - Title ---- - •--. ! BY ..---- -- ----- -- ---- ` (If other than owner) i� L•1 - J FOR DEPARTMENT USE ONLY ---- ---- ` -�f- —DATE :.. •. 7-2 -....-. APPLICATION ACCEPTED BY ..__-t(-- `o....----"" -------" BUILDING PERMIT ISSUED ---- = _ =. _ ,��- -.....----- -• ........ =-DA .„. = T ADDITIONAL-COMMENTS-- -- ___',T.----"---- -... - - ,__ - 2 ...� .. - - -----•- __- Date = +� Final Ins n by: G'r'✓ ' -- - - - - - - - --- --:---......------ ••------- ._ ---. .---- - ----- --- - -- SAN JOAQUIN LOCAL HEALTH DISTRICT