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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. __----_----- __ a f ----------_-_--_-------------------- --------------- This Permit Expires l Year From Date Issued Date Issued __//7d_-_73. 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/LOCAT'I+O-N�-_ A�_�f 0 --__ 4p -----dJ__0__��,7---------R-----------------CENSUS TRACT __. `-1-- ------ Owner's Name -------.---J---2` r_V_---------I~.7CFRea----------------------------------------:-------------------Phone ------------------ ----------------- Address ----- ----- OD-D-5-------------RD----------City ------------------------- •------ Contractor's Name . ---r� _K17 _,F-R\J 1a-- -------------------�icense # -------------------------- Phone -------------------___------ Installation will serve: Residence partment House❑ Commerciah:fTrailer Court Motel ❑ Other --- ---------�-'�-------= f? C Ali -------- s Number of living units:______ ____ ge Grinder��.� Lot Size __ _.______ ___ _ _.___ i ____ Number of bedrooms ___ Garba Water Supply: Public System and name ----------------------------------------------------------------------------------------------- ---------------Private Character of soil to a depth of 3 feet: Sand' Silt Clay Peat Sandy Loam ❑ Clay Loam.�''� f _._,.___---.,Hardpan Adobe-❑ Fill Material ___ __ If yes,type _________________________ (Plot plan, showing size of lot, location of-system in relation to wells, buildings, etc. must be placed on reverse side.) C1 ,� Z" NEW INSTALLATION: (No septic tank or$eep pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK [ �'� Size_t? f� �P_��____.______..________ Liquid Depth . ._.____"___-__,_____ Capacity - ®'------ - Type ate rial--ONCRT No. Compartments ------2,7 istance to-nearest, Well ------ --------------------•Found t ion _ - Prop. Line ----- - ------ LEACHING LINE [ No, of Lines ________________________ Length of each line ` a g , 'D' Boz 'W��5_ Type Filter Material _?C C-r--, =bepth Filter Material 2Y, ________________ {� Distance to nearest: Well __ _��-'`tl Foundation ___��__`�-------- Property Line ___� __�:.... D - _ JJ SEEPAGE PIT �[ �epth _.l.�__t_______ Diameter Z"1\`2�- Number ____._ _______- Roek Filled Yes No ❑ 1 Water Table Depth _______ ___ --- 1( ------ --_---•Rock Size -------------- d t_—Distance to nearest.-Well ------------------1._______---____—:Foundation ----------------ji-_ Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Per it# -------------------------- ___-- Date _________.____.________ _ _ ____) 4 Septic Tank (Specify Requirements) ------- = :-: (------`�=------------- -------=-- ------------ ----------------------------- VA Disposal Field (Specify Requirements) ----_ ;- f. i""""� ------- �t ........... Q-- � --- CAP _ # _� w ---` ` ; ----------------------------------------------------------------- -------------- --- ------------- ----- ------------------- t ,-------------------------------------------------------- (Draw. t_ ~ t ` existin and re aired-addition on,reverse side) ' mit I hereby certify that 1 have preeppared this application_and that the-work-'will be done intaccordance with San Joaquin ! County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local stealth District. Home owner or licen- sed agent signature certifies the foll tin ."I certify t� the perfor nce of k for w h this permit is issued, I shall not employ!any person in such manner as to b'ec _e bject to W man's osation I s of California." r: Signed, -- ------ --------- --------- --k --- -- Owner 13Y `- - --- -- - i Title } ---------------- ----------------------- (If other than owner] ;� !� FOR DEPARTMENT USE ONLY rr��-- - - f APPLICATION (ACCEPTED BY ---------�-i--A ---------------------------------------------- ----------- . bAf E - t 1� BUILDING PERMIT ISSUED ---------'----- _. ------ DAT(` _`-------------------- ------------------ ADDITIONALCOMMENTS ------- ------------------------------------ - ------------------ --------------------------------- { '" ------------------------- �---- . --------------------------------- _�---�V_ __- --- --------- --------------- --�w: � ------------------------ _ .� - __ _--- --------DateFinal Ilspsctioa SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M