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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT / �Y/ .�'�...... Permit No. .. �� .7. .................... f (Complete in Triplicate) ✓•• I!f �y -7y Date issued ....... ....................................... �I This Permit Expires 1 Year From Date Issued V aquin Local Wealth District for a permit to construct and install the work herein Application is hereby made ' the San Jo described. This application i' mpliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .- . ..........................CENSUS TRACT /-.__...::........:.: Owner's Nome ¢-r1.�----.....- ....... ft_ ... one _. �- ............................... Address �4 - city ... a?Sy.3.�. f �� ..7.... t Contractor's Name ........�,........ - ---�-•......... ...... .........-.License # ....-- .. �.... Phone 1 E Installation will serve: Residence Apartment House Commercial []Trailer Court Motel ❑Other ................................••---• ` . ............ Number of Living units:1........ Number of bedrooms ...��..Garbage Grinder .__-. Lot Size ...../......11' .--._.............. [�t.� c------- .....Private C3Water Supply: Public SystemlIlI and name Character of soil to a depth�Sf 3 feet: Sand❑ Silt❑ Clay ❑ Pegt❑ Sandy Loam W Clay Loam 0 Hardpan © Adobe ❑ Fill Material ........--.. If yes,type ----- .............. 1 IPlot plan, showing size of�lot, location of. system m:.relation to wells, buildings, etc, must be placed on reverse side.) j NEW INSTALLATION: IN septic tank 6r seepage pit permitted if public sewer is available within 204 feet,) �� PACKAGE TREATMENT [ ]jf SEPTIC�TrANK z®�'` _-.. .. . ........................ Liquid Depth .. 4� .............. `a � � � Capacity v?4- - Type Material.C. �s�.-- No. Compartments ....... ......... Foundation ..._.-� Prop. Line ..: .............. Distance�`to nearest: Well .................. . _ .I� LEACHING LINE I46 .of Lines -------I__........... Length of each line----- .��..-:......... Total Len th ..f4�................• g �r �p �- 'D'.Box .-- .... Type Filter Material A&C4 ....._.Depth Filter Material __.t. ................ t .__....... Distance to''nearest: Well ............ .' '-. Foundation/..�--- '.....••. Property Line ..---•--._._.... ... fl, `` � -----------_-- --__ Rock Filled Yes No Q SEEPAGE PIT [j) DeptK-�--_---..-•-------. Diameter ----•-- •-.._... Number �. .� r �► .._ p)ZAJJV 6'u rrcp Water Table. Depth _- --------------------•----••--- Rock Size Llt..------- - ....... �iL p. el 4c-.4(—1 4 k��aD stance to n r'es�Wel{ ......Foundation ..��-�'...._. Pro Line .. ............... . t -------- ---- -• •---- - - - REPAIR/ADDITION(Prev,:S�nitatioCReit#':.._....-------------••----------••••----•-- ate _ ._Septic Tank jSpecify RequiremeDisposalFeld (Specify::Requ .�_: .R`:+• -•--- •-••••--; -- f ---------- :..-. r �- n revs �. (Draw existing and required addition o rse side] I hereby certify that l hdv'. prepared this application and that the work will be done inyaccordanca: with San Joaquin Count}r�Ordinances, State La`W,ond Rules and Regulations of the San Joaquin Local Health District ams owner or licais- seed agents signature certifils the4io'llowing: "1 certify that in the perform2j ce of the work for which this permit is issued, 1 shall not employ any parson in such manner I as to become subject to Wiorkma.., Compensation laws of California.'r Signed . .......... `'.... ..... ; Owner ,to .........--- :a4 ._.. .� (If other than owner) IIS FOR DEP TMENT USE-ONLY LI ............. APPLICATION ACCEPTED ::, Y DATE Q....................... BUILDING PERMIT iSSUEQ.-.... D' TES.'.''_ ` ADDITIONAL COMMENTS;.. _-....:...:.. ...... ty�« .3 .. ............................. . - ....... .... I ........... ........... ....... .. . . .. -.-•-:.-.-... .........-._........ �`-•"-"."ij^^`^"! ----•--'•......_...•. ..........I................... .. ..... ......I......................D r - We ...._. ...... Final Inspection b �C SAN JOAQU LOCAL HEALTH DISTRICT 7/72 3 v 13 24 ,_'tea oe., ��i► --