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:FOR-OFFICE USE: A =. APPLICATION FOR SANITATION PERMIT ------------- -- (Complete in Triplicate) Permit No: ------------------------------------------ / ______ This Permit Expires 1 Year From Date Issued Date Issued i ` 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/LOCATIO �7OU_J - ,5 A RIS- ----------------•---------------CENSUS TRACT 5_`_- -- -- -A(t P__HV__T (1/ �7/4R_pN_ ] Owner's Name - ---- --------Phone ---------------------- Address f F l �r y 1-- - City �5 Q ---"--•---- Contractor's Name -------40_lA1_-N_1=-�_ ------ -----------------------------=--------License# E. ' Phone it .s Installation will serve: Residence 0 Apartment House,0 Commercial:oTraile;P4,MW f Motel ]Other Number of living units:---_ ------ Number of bedrooms __ _______-Garbo ge-Grind r-_� j � e vQ-- Lot:Size _.lq-_CREn_�r-•�-.--------- Water Supply: Public System and name -----------------------------------<t-- •------ ------Private�� C J.,. Character of soil to a depthof3 feet-Had an SAdO a Clay Ej Mte real Sand loam 0 YClay Loom ❑ Fill �-r P ❑ {] lf yes;,type ---------------------------- a } '•' �u (Plot plan, showing size of lot, location of system in relation to`wells, buildings, etc 'must be placed on reverse side.) NEW INSTALLATION: (No is tank or seepage pit permitted ifipublic ewer is availcible within 200 feet,) t c Q PACKAGE TREATMENTSEPTIC TANK J2?� Size-!55 �r- -- -�- -.-�- -- Liquid Depth _.__�/'C ----------------- Q Cap66ty, TYAe PFR_ #$77Material' 1 :.R__ ]'nnNor Com \ U ; �_:. ,_-• �.� '[V Compartments ' istance: to nearest: Well `' 0_ _' ;__, Foundation ___'_ 'S _-__ Prop. Line i� g-,..--;.gra •-�1�.�.-.... � . ` k LEACHING LINE o. of Lines _ Length of each line__._. --------r_+--Notal Length; _____________ Type Filter Material _-Depth-Fi.lter Material l Distance to nearest: Well _ ___'rt_-if Foundation .___. • -�1'�_"- Property Line. f SEEPAGE PITp # l r Depth -------------------- Diameter ----- I--- Number ----------------- ' Rock Filled Yes [ No �Q i Wa ---- p -------------- ------==--- --------�---Rock Size - fer Table iDe th 1. r ---- :e----------- l Disr --,�--€ I r f :f Distance to nearest: Well ----------------- ----" ; ..... -- •- ' _ Foundation __ _-- ----------- Prop. Line --------------- REPAIR/ADDITION(Prev. Sanitation Permit# _-_____..__-___________'_-----__Z- l I -----------------------------------------Date ' Septic Tank (Specify Requirements)t______________ ` 1, . P ( P. Y q ) --- ---}- t , ------------------------------------------ Disposal Field 5 ecif a u�rements _t;- t i ---------- -- ----------------------------------------------------------------------------------- -------------------------- -` �_ ----------------- � f[ (Draw existing and required addition on reverse side I hereby certify that I 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 LocalHealth District. dome owner or licen- sed agents signature certifies the following: 'j i "I certify that in the performance of the work for which this permit is issued, I shall natf a ploy any person in such manner 1 as to beco ject to ork n's pensati.on la sof California." `' 1 Signe __. Owner BY --- - - - - ------- ---------- Title ------------------- (I of er than owned - ---- ---' ----- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 `I -------------------------------------------------------- -----------------. DATE _. 12-72.73__x- j BUILDiNG"PERMIT-ISSUED""_. -_ DAT E7---- -- -- ---- - - - ---- ---- - ADDITIONAL COMMENTS ---- -- --------------=i .- E�. .r - - --- --- = T Final Inspects by. �� -- -- - --- ----------------------------------------------------- D- - SAN JOAQUIN LOCAL HEALTH DISTRICT F+;j E. H. 9 1-'b$ Rev. 5M