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FOR OFFICE USt: APPLICATION FOR SANITATION PERMIT - �.,.�, Permit No. /c� »% (Complete In Triplicate) Date Issued 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. 549andexisting Rules and Regulations: ...CENSUS TRACT --•--...-•--------.... JOB ADDRESS/LOCATION -- /`" L� -------T Owner's Name �j4L/ � I F,f� . !'hone Address ----- ------ e6: -------- ••-- / �z .................. City Contractor's Name /ef��.,"/�� ........ ... -----..License . Phone ......................... Installation will serve: Residence ❑ Apartment House❑ Commercial;eTrailer`Court tj Motel.`-]Other . r- - �f74- . .�6 � �� Q- Lot Size,/. o ---�--- Number of living units: �..... Number of bedroo Ggrbag inder .� t i _..Private Water Supply: Public System and name ---- ---- i ------- --- --------------------- - t ,n Character of soil to a depth of 3 feet: Sand T�], Silt El +` Clay ❑ Peat D Sandy Loom ,D Clay Loam 0 Hardpan ❑ AdobeFill Material if yes,type ______... ------ _... (Plot plan, showing size of-lot, location of system in relatiori`to wells, buildings,!etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if�pvblic sewer is available within 200 feet,) 4 _ v PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size._.. !------------ _.-.. ..... ---- .. Liquid Depth ...---.-.---...-----...--- Capacity ........ Type ...... ....... Material---- No. Compartments -.-------_-_._.----- Distance to nearest: Well _.._ ---- -__--------Foundation ------------ ----- Prop. Line ...................... LEACHING LINE ( ] No. of Lines _ ------------ Length of each line...: __ Total Length ,_.......................... l 'D' Box .... . ..... Type Filter Material _. ....... ......Depth Filter Material ..... .................................... jDistance to nearest: Well ................. ...... Foundation .... ..... ......... Property Line ......................... SEEPAGE PIT [ ] Depth Diameter _____--- .._.. Number ________.. -- Rock Filled Yes [INo:Q Water Table Depth ..... __-Rock Size --._ . ---- ' Distance to nearest: Well ---. ------- . _...............Foundation ---. Prop..Line .,....:..._........... REPAIR/ADDITION(Prev. Sanitation Permit# ._ Date_-------- --------- ----•••- --•_) �. + �.M -Septic (Specify ef(Specify' e eements} - r ......... Disposal Field :.. (Sp Y Requ a dad. _ .... -- t. r - -- ----- --- ........ -------- ----- - t (Drayv existing and requited addition on reverse side) i i f I hereby certify that I have prepared this application and khat the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rule's and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- sed agents signature certifies the followings "! certify that in the performance of the work for which this permit is issued, I shall riot employ any person in such manner as to become subject to Workman's Compensation laws of California." - Signed Owner (I l t TitlerT�.. �------ --By ---- . --- . --- yt 41 7)than ownei I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ......t ll f! ... . ........................ '- = _BATE D �*2 _..._.... .. ..... BUILDINGPERMIT ISSUED ..................4----�_".'...A......................................................... . ..DATE ..---- . ...................... --------- ADDITIONAL COMMENTS i i" ...... ............................`:........... , :------------ -- ..--•--"---- _ t ' •---...... .... fn-------- ------------- --------- -------- ----------- -- _-------.---- . w �f -- .....-;......••...... ........ . ••..... '�T ----..... ._ - - ._ ...... Final Inspection by: yv��-. "txF�l#'�Q Ddte .�•i • J.�_. . . .. j.... I SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 '68 Rev'SM +. ,,•�� t,t, ?; t� t. _" _.._,.. ._ . ti