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} FOR OFFICE USE: - APPLICATION FOR SANITATION—PERMIT --------------------------------------------------------- �' {Complete in Triplicate) Permit No: 6_._-/-___57 -- - -------------------------- This Permit Expires 1 Year From Date Issued 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .....IL- �y a 1----5------�(`!- ---- F$C. ----.CENSUS TRACT -------------------------- Owner's Name W_1_ V p .ZR-T- N---------------------------------------------Phone ----------------------._-_---------- Address ------------- / , 4 -�" --- -------------- - -----------•----•------ — 1— Cit Contractor's Name ....... P' ------------ ------------------- =--------License # ---------- - ----------- Phone ------------- ------------- - Installation will serve: Residence &i partment House,M Commercial ❑Trailer Court i❑ Motel ❑ Other -------------------------------------------- Number of living units:-----/---- Number of bedrooms _____Garbage Grinde F -- Lot Size __/4GR - Water Supply: Public System and name ----------------------------------------------------------------------------------------------•---------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay Peat❑„ Sandy Loam ❑ _Clay:.Loam;[}. �A Hardpan Adobe-0 Fill Material __/1017__ If yes, type ____________________________ (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 seeps pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK f[o 77 Size_?xf-1-K---- ---------------------- Liquid Depth --�----.--..------- Capacity __��d __:__ TypeC/�E /�-� Material__�Af(Z_:____ No. Compartments ___-!;.,__--___.._- 41 Distance to nearest: Well __ .... . :-------�t. ,_ :Four;dation ._ --.__--- Prop,,.Line .--.--`5-------_-_-- i 10 LEACHING LINE [l� Na. of Lines _--�-------------- Length- of each line ��-----.____-- Total Length __J,SC�_-•-�---___--- k .... q i� ' �F�..�.-'--- Type Filter Material Filter Material -----�/---------------------------- - 'D'E Bo .�_ - :...:._ Foundation 1�--- _. Pr tim ------ ...... f Distance to nearest: Well _-_J�--------�-_ � '� opar►y [�J p / t / „ , F�, - #toek-fi �! Yes SEEPAGE PIT Depth IX! Diamefer�X ? 11�1un+ber 1, Water Table Depth ` - ------�------------ - -----=----------11odc 5ise .. Distance to nearest: Well ---jAQ�--------------------------'`_.Foundation _-- -- __-- - - 'Nap. )awe ...... __-•--.__-• 0EPARfA001T1111111111(Prev. Sanitation Permit qF --- -----.f ba to _--!- ------ I Septic Tank (Specify itequirements) -- -------------------4-,r---_-_...,,.�..� ----- ----------- -- ---------------- -----=----}- --_..�......_.._. -------- ' ---------------------------- Disposal Field (Specify Requirements) ----------------------------------------------- --------- l- s --------- ------------------------ _. _. (Draw existing and required additron_on reverse;side) 1 hereby certify that I have prepared this application and that the arark will h* dine in accerdan'se with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San;Joaquin= opal Health. District. bone owner or licsn- sed agents signature certifies the following: ; /Y ! "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner "r M! nedbecome.sub' Work s. Com-en ration_lows of Californiaa ' Owner wM, By -------- ` = ------ -- e (��f o ;than ow,ner)_ Cy` Title s � �r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYR,D-------------------------------------------------------- =------ ------------ DATE --- _�_ /- :--------- BUILDING-PER,MIT-ISSUED-_•--- -- --------------------- - =- - T--:_-- --DATE C ADDITIONAL COMMENTS ------ -- ----- --------------------------- - ---------- --------- ------------------ ----- - --------------------- ------------- -- -- --- - --- -- \-------------------------------------- --- --- --- -------------------------- ----- --------------------- ---------- ------------------------------------------- r._.... __ --- _ ----- _--__ . ._.�-._�_._ _--__ - - Final Inspec ' b -----------------------------------------------Date ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT . E. H. 9 1-'68 Rev. 5M