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FOR OFFICE USE: .. APPLICATION FOR SANITATION PERMIT � :..:........................................... (Complete•In Triplicate). ........ _ .�.... _ .. .. . .......-: Permit Nd. _7�_: 7� ....... This Permit(Expires t Year From Date Issued Date 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: 10B ADDRESS/LOCATlUN ....L.�J • _ Ate Dp.� {� t ...-....Z-- .. .... ..---CENSUS TRACT •----- •------------------ Owner's Name .-.. . ................................................. :.....................Phone 6-3Z-Y1 q Address --.-rte✓ 3.5 i ..... A p`�`.....:. #�.• ....:City C Contractor's Name 1VPPH .-. (�FQ.F License Phone -------.-- --••------- -- installation will serve: Residence p Apartment House Commercial❑Trailer Court ❑ Motel ❑Other....Agp? �;KX .-----.......... Number of living units::..-...... Number of.bedrooms -.?.....Garbage Grinder__ Lot Size ._ �� . Water Supply. pp y: Public System and name .................................�_......._.._...:..---_._.._._,........_.__......_:..__........._.._._...Private . . kA Character of soil to a depth of 3feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan 0 Adobe❑ Fill Material 0.....Ifes a..r`. .....•...._. Y ,tyle (plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ,PACKAGE TREATMENT [I- SEPTIC TANK t5 .......... Liquid Depth 9 i Capacity __- 4Z!R..... Type PREO�atedal...(?71.907` No. Compartments .-: If ^--_--� ; +stance.to nearest: Well ..�e . "�`.............Foundation AV—r'f- Prop. Line ---�..t�.............. LEACHING LINE 1' l [ No. of lines ..-...�-----------. Length of each line..-_ fit....--••-•------ Total Length -.•�� .............. 'D' Sox - Type Filter Material r 1 ---.Dept Filter Material ... f�..r. ............................... istance_t•.o. nearest, Well Foundation PropertyLlne SEEPAGE PIT ---- ---- Diameter -------- Number ....... ----_----_- ... Rock Filled Yes No ❑Dep#h Water Table Depth ..-•- -- -_-- Rock' ize . .- Z �_ I -f-- f ..._ r 13istance'ta`tiearest: Well .... lQ.: -- --- -- .Foundation ..� :...��Prop. Line-- ............... •--•• .............. REPAIR/ADDITION(Prev. Sanitation Permit Date :.....:..:...... .:. Septic Tank (Specify Requirements) .......•-•.-............-..............................--•--....:---....: .._...�......... _._,.........._._._._ Disposal Field (Specify Requirements) ................. ------------------------- •-•••-•-••-.-•--•- -----...-._ ., -------- --- ry (Draw existing and required addition on reverse side) I hereby certify that f 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 Heahh_District. Harte owner or liven- i sed agents signature certifies the following: i "I certify that in the performance of the work for which this .permit is issued, t shall not employ any person in such manner as to become subject to Workman's Compensation :laws of California." 4 9 Si red r Owner i /rl ---------------------••---•----- _ Title ...-----=- By M (If other than owner) _ FOR RTMENT USE ONLY _ i APPLICATION ACCEPTED BY_-. [f -0--- - --_--- - -- _ -; DATE _.-. `.: .`. .... ........: BUILDING" PERMIT ISSUED ------------------ ----- ..........DATE ---------.....-.--.-. . ADDITIONALCOMMENTS ------•-•--------•--••-•---•-----------------------•------•- -------------------------------- ...................... -------------------------- ---+-•'----------;-• -------------------------------------------- Final Inspection by: .. ty>: t�'._z�.� _ :_ " .. .:a .:,7-j .... ---- �_ -... ------------------------•---•-------•-------------- ••---.... ........Date ..- ....._...--.....-=......--........---- ER 13r24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M f