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FOR OFFICE USE: APPLICATION F 1t SANITATION PERMIT •.. . Permit No. .,7 S t [Complete in Triplicate) Date Issued 17_11X_.Z'? •............. This Permit Expires 3 Year From Date Issued ,F 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: J08 ADDRESS/LO TION . V...W ls]Ol t7- 1 ,�_. ......: --. - -- .� . __ .....CENSUS TRACE' .:................... Owner's Name .. . ,LC?._ `!k t�------ Ri &41...A...............•-----••-•----••,....-....__.....:... _..-...........Phone .. b.� .ELLS ....... Address ._...: f i S.:-•- Sr1 lR_ O . � City � ``dd iContractor's Name ......................................_--------------- .............. --••-...........License # ........................ Phone ................................ Installation will serve: Residence ja Apartment House C] Commercial ❑Trailer Court 0 � Motel ❑ Other --- ........................................ Number of living units:............ Number of bedrooms ...Garbage Grinder ---/----- Lot Size -...____..._:----__.. _--_---.-.-_-_--,--. Water Supply: Public System and name ......................--------_---._-----_------------- --•-------------• ------------- ..........Private ❑ � Character of soil to a depth of 3 feet: Sand 0 . Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam I, Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type _-----____ ....... 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must .be placed on reverse side.) j I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK[ I Size.......... .- --`--`.. .... Liquid Depth ................... 1 Capacity '6Q , .�"Type .................... Allaterial . _.__......_.. No. Compartments _.-. �........ Distance to nearest: Well - -: .......................Foundation .../ti}......... Prop. line ....s?-.......... 4 LEACHING LINE [ ] No. of Lines .......... �......_-- Length of each line.__.....__ .... _._...__ Total Length r ....------- 'D' Box .... .._ Type Filter Material -- I- -..Depth Filter Material ,� ! i Distance to nearest- Well ._/b 7. _ Foundation .......`�......... Property Line ....:_i&- ""' SEEPAGE.PIT [ J Depth0or . Rock Filled Yes No- .................... Diameter .-..------------ Number -----..._...............__. ❑ ❑ iw Water Table Depth __ ------------------Rock Size ........................-------- ` Distance to nearest: Well ...Foundation ... Prop. Line REPAIR/ADDITION(Prev. Sanitation'Permit# -------------------------------------------- Date ..................................11 • Septic Tank (Specify Requirements) .. ...................... Disposal Field (Specify Requirementsl ........................•-.........................................................._.-•............................................... ..................---................................................................................................................................................ i` _ ._...---------------- -- - --------------- - --._._.....---•----•-•--••-- ----------------................... ...................................................................... ..- . i (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 Joaquln County Ordinances, State Laws, and Rules and Regulations of the-San 3oaguin local Health District. Horeie owner or licen;tr, sed agents signature certifies the following: "t i "I certify that in the performance of the workfor which this permit is Issued, I shall not employ any person In such manner j as to become sufilect tom G pen�ation laws of California," Y :i u ° -. Owner _ Signed -.__ . . ---•- t- By . litle ...................................................... ................. r (if other than owner) ' r w L FOR DIE ARTMENT USE ONLY A APPLICATION ACCEPTED BY --. ._..._. �. -r.. ...... DATE %BUILDING ....PERMIT ISSUED -------------•--...... ••--........-=•--•-----.,__..... DATE , •----..... •----- ---•- rt ADDITIONAL COMMENTS ...................•--•----- .................................................... .................•..........................:............. 11 ----------------------•--- ---- ---------------.........................._.......................... __.._.. x� --.......•---------- .................... ...........•----------••........---• .................... ':final inspection by: -•-•••••...._.. ....••-....... ..-.......-•-• .Dae ... . A . .. . ...... >: 4 SAN JOAQUIN LOCAL HEALTH DISTRICT } H.13 24 1.'68 Rev. 5M 7/72 3 M :$ ;.