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FOR OFFICE SE: ! PPbCATION FOR SANITATION PERMIT 7 -------- --------------------------- - (Complete in Triplicate} Permit No: ----- -------------- ----------------- _ �- �D Date Issued .f- � ___ 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATI N .-----L1--�1 -I---,-�--------1: P O L CENSUS TRACT --_ �_ f�....__. Owner's Nameat" _N------------------------ --------------------- .' f Phone P� '� L city ----------------------------•------- Address ---------- 172-1-1---------- --------- --------------------=--------License ---------------- - ------ ��"''� - - tY - Contractor's Name --------Q_tA1A-F-I�------------------------ Phone Installation will serve: Residence M_A_`partment House❑ Commercial ❑Trailer Court Motel ❑Other --------------------------- ---------------- I �Cf?LG Number of living units:------ Number of bedrooms -_.,�-----Garbage Grinder _A(0- --- Lot Size-_"__ ------- Water Supply: Public System and name ---------------------------------•-------------------------------------------------------]i ----------------Private � Character of soil to a depth of 3 feet: Sand'❑ S It fl Clay ❑ Peat❑ Sandy Loam e Clay Loam, _;'� Hardpan Adobe'❑ Fill Material - fl____ If yes, typ -"_----'--___- 'TT `" (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be paced on reverse side.) NEW INSTALLATION: ' (146 septic tank or seepage pit permi ed if public_sewer..is.avaiIable within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK'[ ] Si eef`_ _�--------------------------- LiMu d Depth Capacity ------ -------------- Type ---------`�~ ----- Material- ------------------ No. o pa`encs ------------.......... \ Distance to nearest: Well --------------- --------------------Fo ndati n.-----_---------- -h-= Prop. Line -------------------- --- •- LEACHING LINE [ ] No. of Lines --_-------------------- Length f each line-- -- ------ " �__.__--- Toto l�Length ___--.-"--."-_....._-_--___ 'D'tBox .----------- Type f=ilter Material --------------------Dept Fi'teer Material - '-------------=-----------_-------•-••- E E PIT Depth .------------ ----- - Diameter -1----- ------- N ------------------------ Proi7erty Line -- ------------------- Distance to nearest: Weijl (,'h------- ------ Foundation S EPAG [ ] p ----------------- Rock Filled Yes ❑ No .� Water Table Depth - i------------------------------------------Rock Site ------------ Distance ---------- # Distance to nearest; We'll -___-__---�---- I-_-----SlFoundation --------------_4 h Prap. Line --_-----__...._.-____. REPAIR/ADDITION(Prev. Sanitation Permit# --- -- __ ______ _____ ------ Date -_---- _-__-----_---_-_--"-- �_l�I} II Septic Tank (Specify Requirements)uirements) --- --- } Disposal Field (Specify Requirements) -A$T--__-�a'. _ y X--- ---------------- ---------- I PAGEP-14- ---------- -- ------------------------- - �'- -` '-------------- ._,_- ....�-_w ------ - -�--------------- --- ------ --- - --- _-- ---` -_ -------- ------- ----- -. (Draw existing and required addition on ' verseide _..,....] I hereby certify that I have prepared this application cnd that fihe work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regula ons ons of the San Joaquin Local Health DiOrict-Home owner or licen- sed agents signature certifies the following: ' I "I certify that in the performance of the work flor which this permit is issued, I shall not employ.'any person in such manner as to bec es to r an's Compensation laws of California." Signed -----------t---------- _ ----------------- Owner t -------- Title ._- = --- --------------------------------- BY ------- (If other than owner) ,. FOR DEPAitTMENT USE ONLY --------. DATE : J 70 APPLICATION ACCEPTED BY --, "t'i_R- / !� �— 4 �- BUILf51NG-`PERMIT-I=ED - ----- ----------------------- DATE'----- --------------------- ----- i ADDITIONAL COMMENTS --- _=_ ( !f - �� ------------------ ---------- v-- - - ---- ----- - =- ---------------------------------------------------------- - ------- - --- --- ----- - -- -- ---------------------- -------------- -------- ---- -- ------ --- - -- ----------------- ----------------- Final Insp -` ---- ~ --- -- - _ - - -------`------------ --------------------Date•------- � ----------- --------- - .. SAN JOAQUIN LOCAL HEALTH DISTRICT r .. E. H. 9 1-'68 Rev..,,5M '"