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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expires 1 Year From Date Issued Permit No. Date Issued `v� 71 Aoplicotion is hereby made to the San Joaquin Local Health District for a permit to consM,ct 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 /�'`�1,�-�=. �`""^u Sy r 15US TRACT .�ZS'-. U.P� -4' n' Owner's Namc-�%c> ..__ .....»....... _Fhcne .. - ,- - r� � }�--•---- ----- ---- Address - - O C94s� lC .. �.�ffc9��s"✓r..t,""'._,�.._...... City .�x�'.................... Contractor -s Name irl^`^-r-v--...+r-._...license # If� ��Y.... Phone Installation will serve; Residence ❑ Apartment H -E❑ Commercial ❑Trailer Court ❑ Motel F. Other Number of living uriitS:r Number of bedrooms ........... Garbage Grinder Lot Size ..•...Priv _.._.__....-------•--- water Supply: Public System and name _.. ...... ........ _ ....................................-•---Private � w Character of soil to a depth of 3 feet: Sand 0 Silt ❑ Clay j] Peat r]' Sandy loam ❑ Clay Loam D Hardpan ❑ Adobe [_' Fill Material .._ If yes, type _ ;Plot plan, showing size of lot, location of system in reiation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: tNo septic tans: or seepage pit permitted if public sewer is availoble within 200 feet,} G PACKAGE TREATMENT [ 7 SEPTIC TANK [Pf SizefiWx..% � � � - ✓�. �.... --- Liquid Depth Y: ------- L21 -------_s Capac ty ?+✓jig Type - Material.,e4el~..-_-- .. No. Compartments ..'-.-.--- -. UU NFoundation !.B Pro Line _.._.5.-.---..-.-.- •�,•� � Distance to nearest: Well ..�....._.la�_..__._-... � - - p• lam• ._....- [ 1 No. of lines .. ...... Length of each line i-C_o r ._. Total Length .... 1.0?.P------------ t •D' Box 't .__ Type Filter Material .�_R--. Depth Filter Materia! 1�i .- - -- . �- Distance to nearest: Well -_--- Foundation Propert), Line ..._.._.. _....-....-- 3 SEEPAGE PIT [) Depth ---- r. __ Diameter Number _ Rock Filled Yes ❑ No 0 Water Table Depth ..... --------....Rock Size .......... - Distance to noorest: Well . --------- Foundation ...... Prop. -Line-------------- REPAIR/ADDITION (Prev. Sanitation Permit # ....._..._.._ Date ...................... ,...r - _ .-----_.. Gj Septic Tank {Specify P.equir_Pmentsl- ............... -.---....---•-....... .......---• ---• -------- - - -- .J i= Y Disposol Field,' (Specify- Requirements) --M ... ...................................... .. .._._ ._........ ......... D •-- ..... ............................. _ _.......... ............ _ "' ..__.�_......... . ---• -•• -•------------•--......... ........................ i ............. •..... .................. �� - + �� (Draw existing and required addition on reverse side] 1 hereby certify that •1 -have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulaftons 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 winch this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." S greed _. _ n .. Owner ... ..... By /t+QiIJVIi r�. Title PI=.Q. ......._....__............ .. (If other than owner) �FOVDEPA1tTM :NY USE -ONLY APPLICATION ACCEPTED BY .-7 t1 x,:C`....._................• _.....--.....-.».............. DATE ? -._� ...•.... BUILDING PERMIT ISSUED -DATE . DATE ._. ... ........ ADDITIONALCOMMENTS --•-........................ ...-----•.............. .... _.__...... ..... ..... _........... ......... ......... ,...._..... - - ................ •....... . ............ , _.._ ,'...:... ....... ........: ..... ..__.............._ � . ---..... ................ ..._.� ... Date / Final Inspection by: 1--^e :.._....... _ .--- ........_..._. --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M-