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FORF'OFF.ICrUSE: _APPLICATION FOR SANITATION PERMIT Permit No. -��--- 7 --- ------- ----=--------------------- i �,J lComplewin.Triplicate? ---- -- --- ------------- (}�]r _ _ _ Date Issued -------------_7v This Permit Expires 1 Year From Date Issued ------------ ---------- F ' e to the San Joaquin Local Health District for a permit to construct and install the work herein Application is hereby mad described. This applkatior is made in compliance with County Ordinance No. 549 and existing Rules anld Regulations: k JOBIADD[SS/VOC ATION .--------��--W. CIA ----�,---- II r. NSUS n American Assembles of {hod-- ----------------- ----CEPhoneR--�'� `"--.941 -- Ow is Name ------]--�'-t� - I1 9th 3t. ------------------ Cit Stk' n_ t Address - ------------- - Y4'65-8798 --------------------------- 225 �� "P .Les!! Se tic Tank Service - Licerse # -261737----:-- Phone _J_-s"'-----9-•----------- Contractor's Name -------- -' ---- -P_ 0. Installation will serve: " Residence [A Apartment House[] Commercial'❑Trailer Court iMote! ❑Other ---------------------------------------I----- Number ------ --------- -------------------------- Number of living units:---1------ Number of bedrooms ---2----.._Garbage Grinder .___---_---- Lot Size -- -_ ---- i Water Supply: Public Syst m and name ---------------------------------•---------- ----------------------------------------------- ------�.Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay E] Peat E] Sandy Loam C1 Clay L is m ❑ 1 Fill Material ------- --- If yes,type ------------------ - Hardpan ❑ Adobe�C] -,I "---" Plot` fan, showing size)-of lot, location of system in relation to wells, buildings, etc. must be placed' reverse reverse side.} -� ( P INEWkINSTALLATION: (No septic tank or' seepage pit permitted if public sewer is available within 200 feet,j II Liquid Depth ---------------------.----- i KAGE TREATMENT [i SEPTIC TANK'[ ] Size------------------------ ------------- PAC Material---------------------- No. Compartments -----------_-----. [ Capacity==----------------<- Type ---------------- { s Foundation ----------------------.Prop.''-Line ---r---- -- [ DistanceL to nearest: Well --------------------------- Length of each line �a---------------- Total Length LEACHING LINE [ ] t o. of iLlnes --------1 g p [ 'D' Boxtti�}_il_f _ Type Filter Material -----rQ_9K---Depth Filter Material ---_---8__I---:-------------------------- Q �l ,., ; ------------ `earest: Well --SD__plu8-__ Foundation _1 __--_P1AA_ Property Lin�._ t Dis#once o'�n Rock Filled Yes ]] No SEEPAGE PIT [ ] Depth --- ------------ Diameter Number - ra Water Table Depth ----------=--------------- -------------- •---- Rock Size -------------------------- ---- ^4 " ! .=Foundat on ^----------------- Pio Line = -------- Distance, to nearest:T!Il _-_--___--_---___- REPAiIR/ADDITION(Prev.°,Sanitation Permi't4f---------------------------------------- --- Date Septic Tank (Specify Requirements) ---- -------- ---------------------------------- 1 k 2 a 1 it I Disposal Field (Specify Requirements) A- _d 90-_� - pf_-X aeh'_ o 41 ----------------------=------- 1 \ IN _ -------- \J--- - - ---------- ----------------- --- -- --------------------------- ----= ------------------------------------- k„ (Draw existindtand required addition on reverse side ' �J°� �' r this application and that the work, will be done.in accordnce,�with San Joaquin I hereby certify that I have prepa ed pp County Ordinances, Sia4J Laws, and Rules and Regulations of the. San Joaquin Local Health District' Home owner'or licen- 6l6' sed agents signature certifies the following: [ "I certif that in the erformance of the work far which this permit is`'issued, I shall not employ any person in such manner Y p as to become subject to;,W orkman's Com ensation law of California." ,_ i / -- Owner, Signed --- ----- -- - - --- --- - - -- - -------- Title Of__-Pay_-�Le$----Septic-_Ta Se T - BY -------- ---------- - • I� Tian ow erry Warthan I�� # FOR .DEPARTMENT USE ONLY t. 4 i O i APPLICATION ACCEPTED BY ____- - _---- i/__ DATE --------------------- _ ATE -------- � �--------------------------- ADDITIONAL CO ME TS - _fj' h} # BUILDING PERMIT ISSUED --------- t __-_. =., ; 9 �t - -wE - (________________ i - •rif r s' -" ------ -- --------- - ------ ----"-------------------------- -------- -- �------r--------I--:--------------yam _` ---------- -T--- ------------- ------------- ------ ------------ l_---- ---- � ,�L --------- ---------------- _ - - - _. ---- ------------ Date ---- ---- ---------------- Final Inspection b f SAN JOAQUIN LOCAL HEAL M. TH STRICT/ ` �. E. H. 9 1-'68 Rev. 5 .,I N C5�kvoip — - -