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rvx 01-FICE USE: _- APPLICATION FOR SANITATION PERMIT' ...... (Complete In Triplicate) Permit No. .7�-•-�_ .. ' ..................•............ ............ This Permit Expires ] fear From Dats issued ba,fe issued Application is hereby-rh6ide•to the San Joaquin Local Health District for a permit to construand described. This application is made in compliance with County Ordinance No. 549 and existing Rulestand Regulations, JOB ADDRESS/LOCATION �j . •�••,C •P,S fo�i` /'�, CENSUS TRACT ........................ Owner's Name ...... .. . Address / G - ........Phone�. T9..t �s',,,� {.�er! ..-. city . •- �.I ............... Contractor's Name ._ _ .-~A( .-GJ-Zde�- v ,rr -------.License # APOCP4*9 Phone Installation will serve: Residence{Apartment House[] Commercial j]Traller Court ON Motel ❑Other .----------•-_ •------------- ..............- Number of living units:_.-_--_ Number o€ bedrooms _. _- ...Garbo a Grinder /7.c+r7. Lot Si ze . Water Supply: Public System and name ............ .................. - ------•---•--------•-•-------•--------------- ...... `Private❑ Character of soil to a depth of 3 feet: Sand j] Silt j] Clay ❑ Peat[] Sandy Loam j] Clay Loom ❑ Hardpan[ Adobe Fill Material yes,type❑ If es a ... -•-• ..... (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 Fu lic sewer is availabl within 200 feet,) 6 PACKAGE TREATMENT [ ] SEPTIC TANK v I Size�lflJ_ .1..��fQ . r Liquid Depth v ..-•---••---...... CapacityJ7QQ--_-._.. Type �:r..:-___ Material._ S_ b-...- No. Compartments _..Z 7%-/ % •............r[( Distance to nearest: Well ...... r..:--'----,----:_:'_foundation - Q*:--.---- Prop. Line ..•...--- ` Lin, r LEACHING LINE,LINE [ I No, of Lines ----_- -- Length of each Zine----- Q--------------- Total Length l]' Box'.e;00.7 Type Filter Material,0-4FJC ....Depth Filter Material M l Diameter"" .. Foundation _/0_0 ..... Property Line ....X-106.........fi i SEEPAGE-�-.�.,..,..... Distance to nearest: Well ..�"�?--f [ J De Number . Rock Filled Yes No WAihf T eP :.. ------- .....Rock Size,,: ...----=•............... �. istanca to Barest: Well. ......................Foundation --------_--------- Prop. Line .............••....... o REPAIR/ADDITION(Prey. Sanitation]Permit# _....._..^._...._............. pate ..................... 3 Septic Tank (Specify Requirements) .......................... .......................................................... Disposal Field (Specify Requirerrents)�. w_-- 1 ., r SCJ' ..... ----- -------••------. �+ - •--------------- _._. (Draw existing and required addition on reverse side} 1 herehY certify that I have prepared this application and that the work will. be done in accordance. with Son 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' as to become subject to Workman's`Compensation laws of California." l Signed ------------------- 'Owner { ww � BYfir. - --- -- ------------------------------------------------------ Title J ' (if other than owner) I r 1:0 EPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- ---------..--. - DATE ! � �� BUILDING PERMIT ISSUED .-- DATE -- - ------••-•--------------•------------..._.------ - Dl7IONAL COMMENTS -=-------------�----------•------•-...----- � ------• - - ---------------------- ----- ----- ------------------ .----•------ ----------- ------- -----•----------- ............................---••------------ ............... .................--..-..--------- --------- . Final Inspection b _ - f - - p y: -.-.... r.._- ---------------••----------...-----...--....--..--------- -.Date . % �.•_ Eli 13 2h 1-68 v. 5Ai � ------------- ---- �, SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M