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F F FOR OFFICE USE: SANITATION PERMIT -------- -------------- --- ---- ---- (Complete - 11--- Date APPLICATION OR P P Permit No: 49----- ".� ! Triplicate) ------------------------------------------- ----------------------- ----------rr--- tfl u _________.!_____ This Permit Expires I Year From Date Issued Date Issued . -_-1�.-la 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. 3.49 and existing Rules and Reg lations: JOB ADDRI SS/LOCATION, 3 _W_=,- L- /►s!/ .----- CENSUS TRACT = - Owner's Name - ----- 1''l �� - _ - 'C7 .---------------------- - --- ---Phone _ _ -" ' ----�? SI A RD rH_Rr = 4 Address 1. City .� ------------------------- - - --"-"•--- "-=-----= I-Pf, �", License # Phone ----------------------- ------ Installation s Name �=---1-�-=-------- C�-�--- t---`--------------------- ------ - - 4 Installation will serve: Residence Wpartment House'❑ Commercial ❑Trailer Court ;❑ . Motel ❑ Other ____ ' g Z---:___Garbage Grinder Lot Size ---�1 kXT#4_C�--------_" I Water Supply: Public S stem and name ----------- --- - -- um er o living units:___°� ____._ Number o bedroom pp Y Y ` - =-----------------------------------------------Private [� i Character of soil to a depth of 3 feet: Sand'❑ Silt L]. Clay � Peat E] Sandy Sandy Loam -E] Clay Loam ®f_ 4 ti i� Hardpan E] - Adobe E]- FiII:Materialy95_ If yes,type ----AANr -- ------- (Plot plan, showing size_of_lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:; (NoiM septic tank or seepage pit permitted if public sewer is available within 200 feet,) I - - ' PACKAGE TREATMENT { ] SEPTIC TANK�[ ] Size__�� I_G'_ �_, —�___._.__. Liquid Depth _._. it _.I Ei ' v" _p 'Y" i Capacity -� - _ -- Type&VA _D__ Material C_V6jC- No. Com artMents _.__Z. :_.._.__ Distance to nearest: Well . SQ--------------_----------Foundation ----/_C�.�_'----------- Prop. Line _,_.:4�7__-:_____ ` LEACHING LINE { ] Nof Lines _____- -___.___.__ Length of .each line_____ _______._____ Total Length .__ ___--:___ j 'D.'' Box. Type Filter Material _ _± _CI :_Depth Filter Material ------ V _-___.____-_ Distance; to nearest: Well __.--------' Foundation ---------------/I..-__ Property Line i� - E ___..____ Rock Filled Yes No ' SEEPAGE PIT [ ] � Depth ------------ D`iameter,� .-_-- ___-- Numbers 4______________ ❑ Ip Water ;Table Depth Y=` "--`-- -- .- -------------------Rock Size ---------------------------- lM Distance to nearest: Well ----------------------------------------Foundation --- -.---- Prop. Line -----= --:-----____-- REPAIR/ADDITION(Prey:•Sd`nitation-Permit# --------------- ---------------------------- Date -----------.----------------------} Septic Tank (Specify Regl irements) -------- -----------------------------------------------------------:-------------I-------------------------------- "------------=------ Disposal Field (Specify Requirements) ----------__ ----------- ---------------------------------------------- ----------- j , I -------------------------------------------•------------------------------------ ----------------------------------------------------------------------------------------- = ��. s i i. - --------- s:i - ----- - ---- �I' '(D'raw existing and required addition on reverse'side) *•-- E I f ! 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 Local Health'bistrict. Home owner or liven- , sed agents signature certifies the following: "I certify that in the performance of. the work for which this permit is issued, I shall not employ any person in such manner as to becor t o nsation laws of California." Signed -------------------- Owner � � - BY ---------- - - -----------------------I------------------ -------------------- ------ Title ----------- -------- ----------------------------- (If --------- --- ---- (If other than'owner) f FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BYr - DATE ----__- :---__-- ------ ----------_ ----- _ - -- ------DA - -'PER'MIT-ISSUEPER'MIT- SSUEBUILDING ADDITIONAL COMMENTS 'j r -----------,_ ---- --- ---------- ----------------------- ------- ------------------------ ----------- -- ------- - ----------- ---------------- --- Final tion b �T/lL �?� - Date------. _`��/_�- ---- --- ------------ r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M' 1 ` ?