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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---.........I............ . ...__-•-- Permit No. _ ,".3 .-- (Complete In Triplicate) . -- {( � Date Issued _ .-_........... ................. ' f ! This Permit Expires 1 Year from Date Issued Application is hereby made to the San Joaquin Local Health District forapermit to construct and'Install the work herein described. This application is made in com lion with County Ordinance No. 549 and existing Rules and Regulations- ,A JOB ADDRESS/lOC TTION ... �_........-.... ..r1 fir' " ................................CENSUS TRACT .......................... Owner's Name .._ (..fC� l -•-7-.�f}*94FR4r_1 K.....--•-- ............................ one .. - .. � . .. ..---.Address ..._ So .4�—i ' *0(—............. .... City .._._....- ! ................................. Contractor's Name ---•T� _ `5---._5��'1�_... > �� ..............License I -; _y .... Phone Installation will serve: Residence 0 Apartment House Commercial QTrailer Court 0 tt Motel ❑Other----------------------------•-•--•--........ Number of livingunits:-6 Number of bedrooms ........Garbage Grinder .... .-_. Lot Size ............................................ Water Supply: Public System and name .-___-__. .... V�:f"'�......................... .............Private 1 Character of soil too depth of 3 feet: Sand b Silt❑ Gay o Peat❑ Sandy Loam t Clay Loam ❑ Ha_rdpan_C]_ Adobe-0 -Fill-Material ._........ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse aide.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer.is available�with€n 200 feet,[ PACKAGE TREATMENT [ ] SEPTIC TANK 1 3 Size..._ �- --- Liquid Depth �..:...... ---.}r'f v J Capacity 1.200_._.__• Type __d. 49Aaterial------_____...---_•-__ No. Compartments ....I...... __-....... 6 ...I oe Distance.to nearest: Well ,!J040 _.Foundation Prop. Line 4V_ A' LEACHING LINE ] No. of Lines -_ $................. Length of each line..- .. Total Length .....-y-110............ ©' Box ----.._._:.. Type Filter Material .....................Depth Filter Material ............:.........._................._._ NA �0 . Property Line O Distance to nearest: Well ...... �__..._. Foundation ------- •----....-_-- ....... ................ rt SEEPAGE PIT [ ] Depth -----� .�------ Diameter •_. . ---.-�.....__.._. Rock Filled Yes No � p. �1�.- .... Number :--•-------- �I � .-_Rock Size 9 Water Table Depth ........ � .......: �..........._ Distance to nearest: Well -------ISO......................Foundation ..... Prop. Line ....... REPAIR/ADDITION(Prev. Sanitation Permit# .........._.....................---_........ Date ---------------------------t. .} S Septic Tank {Specify Requirements) --• ------------------------------•--------_.__o .._......._............ .....w _� ....__._...... .... .... r a Disposal Field (Specify Requirements} •_.-- -� l..S. , ... iltu...-.... a -- ---- -- R..[� ----- V -------------- --•--------- ---•-•-•---•-•---------•-------•• ------------ --------- .......................... ..........................._._............................ IDrow existing and required addition on reverse side) I 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 Regulations of the San Joaquin Local Health;District. Home owner or licen- sed agents ' ature certifies the following: "€ certify at I the performs the work for which this permit is Issued, I shat] not employ any person in such manner as to b s jec# to a 's e . a ' laws of California." Signed ......I.............. Owner By ---- ---------------------------------------------------------------------------------•--• --..._ Title -- -------------------------------- .................................... (if other than owner) en A R Dr RTMENT USE ONLY APPLICATION ACCEPTED BY - �. — _ ............. DATE . "'�- :707-_ .. --------------- BUILDING PERMIT ISSUED ---------------- ..................................---------------------------------------DATE -------------------------------............ ADDITIONAL COMMENTS --------• --------------------------------------------------- ..................... i ----------------------------------- -"4A61----- �' - - ; -e ------------------------------------------- ------- --- --- ............--- i2 ----------------------------------- ------ - �� _ ......._Date _. .. I=inal Inspection b ---•----��- EH ]3 1—btl Rev. f/ 1 '/LOCAL HEALTH DISTRICT 8/7h 3M t