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FOR'bFFICE USE: APPLICATION FOR SANITATION PERMIT -------- ------------- Permit No. 7�-3--5- 6 (Complete in Triplicate) ___-____-_________________________-_______ This Permit Expires 1 Year.From Date Issued Date Issued 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/LOCATION � f� -----CENSUS TRACT --------------............ Owner's Name ---�� ----A014VAV1,05ma------------------------------------------------------- --------------------Phone Address �'� -/Y'-----llzAee Setv---S?_7---------------------.--. City ----------- Contractor's Name ___�� � aF'd- est -_-. --_--_-_.License # 45' _173-_ Phone Installation will serve: ResidenceXApartment House,❑ Commercial ❑Trailer Court l❑ Motel ❑Other ------------------------------------------ Number of living units:--.3------ Number of bedrooms ._,_4------ Grinder ------------ Lot Size - _�.r .............. Water Supply: Public System and name -------------------------------------------------------------- ------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam. Hardpan ❑ Adobe J( 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 'i PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size_---_---___-•------------------------_--_--_ Liquid Depth -----_-_.--.__-...__-.-_- � 15(/^/ Capacity --------- ------- Type -------------------- Material- --------- -- No. Compartments __ w Distance to nearest: Well _-_--- __-.--:_--------------------Foundation - --- --------- ____ Prop. Line ...................... LEACHING INE [ ] No. of Lines .-_-_�_.--_---.-.-- Length of each line------ --`--.-_--._ Total Length .__-60-.............. S V `,5, D' Box -�. Type Filter Material __ ---------Depth Filter Material -----,1 -- _-_.......................... �-- Distance to nearest: Well -.SZ?_�_--_-----_-_ Foundation ...-1Q_____________ Property Line .__- .__-.... ......... f Ire SEEPAGE PIT Depth --.25---------- Diameter Number ------.-- _ Rock Filled Yes j� No it G/, (57'�� Water Table Depth _-_l©�---------!-________________________Rock Size -. _I�_�-_ ______ Distance to nearest: Well -.11f -----------------------------Foundation Prop. Line -.._.-.--............. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------_......) Septic Tank (Specify Requirements) - ---------------------------------------------•-------------------•-------------------------------- ' P p Y q .4f Dis osal Field (S if Re uir-ments) Li€ /1_____ --__ - J ,. c. �sT,nrg •� '- -`------------------------ ---------------- ---------------------- (Draw existing and required addition on reverse side) 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 District. Home owner or licen- 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 beco s bject to Workrpan's Com ensati.on laws of California." Signed = -- - ---- ----------- Owner By ---------------------------- ruin, ----- -- title ---------- -------------- ----------------------- ---------- --------- (If other tha wned DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ---------------------------------------------- DATE �/— �--------------- BUILDING PERMIT ISSUED -------- - / ---------------------------------DATE ------------------------- ------ ---------- ADDITZN= CO MMENTS -- ---- ---- ---- ----------------- ---- -- ---- --------------------------------------------------------- -----fi-r----�---�-- -=-------------------7y----------- -- ------------------- - ------ - nt----- ------ y _---_--- - ---- -- . - t-------------------------------------- ------ ---------------------------------------- ------------ ---- Final Inspection by: -----------------------Date --- ------ -- ------- ------ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M