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' FOR 0410E USE: APPLICATION FOR .SANITATION PERMIT / ......-•� -----•--•-•-=-�"�•R--- Permit No. /r� .1."� (Complete in Triplicate) j _. Date Issued --,- �l -------------- This Permit Expires l Year From Date Issued r 02S•-O J-O-C)Z— Application''is hereby ode to the San Joaquin Local Health District for a permit to construct and install the work herein described._Thisapplicatiori pis made.in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO _? T .: ----- *{ !1ti= v.., ..CENSUS TRACT . ' Owner's Na ... ...... . _. ------- ----------•----------.........._- ...._......................... ... Phone Address ------ .'Y7 ., city Q -P �e.............. st 0 , -•----------•------------------------------ Contractor's Name /Lrrc.c2..41 . F. -.. License#rPhone _--•-- ' Installation will serve: Residence ❑Apartment Hoy0e0 Commercial❑Trailer Court i❑ Y S • Motel []Other___ ___ _ _ ________.4 , Number of living units:..... Number of bedrooms --.._--._..._Garbage Grinder ..._.---_--. Lot Size .--__-_.._................_- ........... f Water Supply: Public System and name ---------------------------------------•.........••--------••-----••--•------------'------•..............-------Private OR-- Character of soil to a depth of 3 feet: Sand[] Silt❑ °:. Clay ❑ Peat❑ Sandy Loom,1<Clay Loam ❑ Hardpan ❑ Adobe ❑0�Fill Material ............ If yes,type..................__....... (Plot plan, showing size of lot, location of system stem in relation io'.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�[ ] Size.:..:....:...•---....._....-------.....--.... Ca _. Liquid Depth ............... Capacity _f Type .................... Material_. - No. p Y ..}�. . .- ,--- - : yp T ------------------- Compartments ----.................. 0 ' Distance tot nearest: Well ----------.......................Foundation ___.._--_-_...._. --- Prop. Line ....................... LEACHING LINE [ ] No. of Lines ............. ::-__ Length of each line-!__-_......._...._._._._..- Total Length ;_.-___-_--.._---_-_. 'D' Box --- -------- Type Filter Material .............Depth Filter Materia! . ----------------- l ----------_----•---------- •------ Distance to nearest: Well ........................ Foundation ------------------------ Property Line .................... SEEPAGE PIT [ J Depth .._-_-_. ❑ 0 ..__.._._ Diameter ---------------- Number'.........-.-.-_-..__.._-__-. Rock Filled Yes No �;Z� Water Table Depth ......................................__------Rock Size -._.................. ......... i E Distance to nearest: Well ......................................:Foundation -_._.__--__--_.-._.• Prop. Line ...................... `C ' REPAIR/ADDITION(Prev. Sanitation •Permit# ..............................................Date .................................. w, 9 SepticTank (Specify Requirements) ..----------------------------------- ---••--- ------------ .................... -------••-• --..........• --------- Disposal Field (Specify Requirements) .. ,c .-�tf.-rc�,G�` ..� �/ ,r.- =�,c. _ . _... . . ---...... 1� --------- ... � G� --; :sem. ..................... ------- ----------- �_.....------------•--•-•--...... ............................................. .......................................-....---............................ .......... (Draw existing and required addition on reverse side) hereby certifythat 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 [icon- sod agents signature certifies the following: ' ddi 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 lawi of California." f t L Signed - _-----•--_--• .' Owner By ................. ...`... ......................... -,�.��_kJitle,__-/ -Vis. 4-4a4). ........-•---•-- --- •-----......... ' (ifotherthan owner) t Q FbR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY . 0 ---------------- ---- DATE .3...3 a ^7'.r BUILDINGPERMIT ISSUED --------------------------------------- ---••------------------------ ..............DATE .---•--•-----•---- ------...--.......----•- ADDITIONALCOMMENTS-------•----•--- ---------------------------- ------------------------•---- --------- = = i .-_...-•-•-- -------------t............... -----------------------------•------------------------------------------------------------------------------------------------.-.... -----------•-i�13 ................................... .. --••- •----- - r FinalInspection by: x.... .. --• ..............................=-------------------------------------------------Date --.--•------?..�-••---•• --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.