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' - -' �` '�"_^,"q+r.-��-'�--+�''Si:3rran��...r.,.,,,,r�y;..:,•r-•1wa�y« �E FOR OFFICE USE. If APPLICATION FOR SANITATION PERMIT ..... {Complete in Triplicate} Permit No. _... ................ r-..__. fi . `�.: '........................... .........................il.... This Permit Expires .1 Year From Date Issued Date Issued /�: i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This opplication'iis made in compliance with County Ordinance No. 549 and existing,Rules,.and Regulations: r JOB ADDRESS/LOCA7IQ .E. i� ............CENSUS ACT Owner's Name ..._t..�Gl. Phone_............. .. . �......--•---.. III ,d Address ...... ........... l.. .. .11907- ........ City ` �......... .... . D . ...................... . .. Contractor's Name I'........_ License # .�/ .�-c-:Phone ------------------•---- Installation will serve;. i Residence airportment House❑`Commercial ❑Trailer Court Motel ❑Other . Water Number I g Number of oms . Pp y: hilt S stem /� ----Lrba e Grinder��-.r._ Lot Size . ./..�._..�!-��.�.--.•...__� of living unity to � and name ....( —11' � h i s.. ,_. ...�- ........... ....... Private ❑ Character of soil to a depth of 3 feet: Sand b Siit❑ Clay ED Peat❑ Sandy Loom ❑ Clay loam ❑ Hardpan ❑ Adobe Material _A"'& If yes,type -------------------- ------- (Plot plan; showing size ofd 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 TREATMENTC SEPTITANK Size....,'_-�dS',X-__ -•---•---•--....._.._. Liquid Depth ..� Cty e �-•--•--•- apaci ._�" ---- Type .-P/W .�aterial_.. c-� _ • _ .. ..-� _ o. Compartments ............. ........ ante to nearest: Well ..._. Foundation ...-.40............Prop. Line LEACHING LINE [ No. of Lines _.. -- g d,�1 ----•• Total 'LeInth r _• •-------------- Len th each line.. _ D' Sox Type Filter Ma�terialFDe th�'Filt '� '. _..t p ateriaPl er--M 1 istlance o'nearest: Wel! '.__.._.._ ;... _.. eto-,�j-.... Foundation �- Q- ro e SEEPAGE PIT [ ' , -KDepth .. J_ Number......... . ... Dia er ,� -_-- �_... __..__ Rock Filled rty Line Yes I( ...,—. _ Water Table Depth ••- -------------------••--=-.:Rock Size-. /ice/J f�---•-- /� No bistance to nearest: Well ...... �_---_-- Foundation . ....•... Prop. Line .. ................ REPAIR/ADDITION JPrev. Sanitation Permit 0 ...... Date Septic Tank (Specify Requirements) ..................... Disposal Field (Specify Requirements) ......... ;t_______ _ - '_,-- � ............----------- ••-•---•...........................................•••---- ................................................ (Draw existing and required addition on reverse side) 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 far which this permit is issued, I shall not employ any person in such manner as to become subject to Work'man's Compensation laws of California." Signed ............. . .L . Owner +` By .................:.... :S ../L.... --... -----.- Title �..f. �.. 4�1..._. --•---•...... oche an ner) � , FOR DEPARTMENT USE'ONLYAPPLICATE BUILDING IOPERMIT ISSUED BX.: = '.................. DATE .}..�'L..-=-11f•`•--�r----•--- ADDITIONAL COMMENTS :.._.. ----------- ..................'...DATE ._......_•-••-••••... ................... ..... ::. ._ ---•------------------ ............................. ----- . t Final Inspection by. D • - ---- -•• ...•--•_... ate . F SAN JOAQUIN LOCAL HEALTH DISTRICT- E. ISTRICTE. H. 13 24 � i 1-'68 Rev. 5M �� 7i7 1) 1 u l