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FOR OFFICE USE:-- APPLICATION FOR SANITATION PERMIT =- -------------------------------------- Permit No: (Complete in Triplicate) - ----------------------------- - ---------------•-------------------------_--------------- This Permit Expires 1 Year FFA- bate Issued f Date Issued Application is hereby made to the'San Joaquin Local Health District fore pp Y q tit 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 .--2329-Y-----F7 DDRESS/LOCATION .__.1329_ 1 l,_ -� h'-�1dC` CENSUS TRACT 5 Owner's Name _ '�- --------L.Phone_63-8.-ZZ._- Address ------- _2_ - 'l r1 -------/��-------------- --------•--- CitY s�C }LQ --------------------------• ------- 1 ( 1 SLf Contractor�s/Name ----- W:=N — License# Phone Installation will serve: "`t Residence partment House°[] Commercial ❑Trailer,eourt ❑ I Mote .❑O -- Other ----------- ----- - -- f r AZ; Number of living units:--I------- Number of 'bedrooms _3-------Garbc�ge Grinder _ d_.n Lot Size ___/ _4RiA .__________ Water Supply: Public System and name i I- �` - Priv to Li Character of soil to a depth of 3 feet: Sand' [1 ( � � � � p p Ti Silt: i.❑C,la Peat �t Sa'd� Loam ____---Clay-Loam ❑i -� i lard-ao Adobe Fill Nlbtefial'#16t- ! (Plot plan, showing.size of lot, location ofr system in relation to ells, b�ings, etc. must be placed on reverse side.) NEW INSTALLATION. (No septic tank or seepage if4permitted--if-public sewer is a ailable within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size- ------------------------ _ Li [ 7 [ a l , , ------ --- - quid Dep�tJh -----------------•---.----- / F _�_,.�•T..-�-. Capacity ��r Type ------------------ Materia -�---------- ---- No. Compartments -------------...... . Distance�to} nearest: Well ---------------r_- - --- Prop. Line -------------_........ LEACHING LINE [ J N�'\ Ines --------------- ------ - Length of each fine-----------`v .------ Total Length ._..---------- D..% Box ___Type Filter Material ____________________Depth Filt r Material --_____- __________._______________.__.___. Dell ------=- Foundat-ion --------- -----------Property Line. --- ---------------- w ------•-• ---- SEEPAGE PIT [ ] t Depth 'Distance to neare-- W(am,ter 6 __-------------- Number ------------- ____.______-_ Rock Filled Yes ❑ No .0 Water Table Depth f f __ ick Size_ ------------------------------- d ,� ti----------------------- Distance to nearest: Well_- 1__--_ '=`�,_�►------------------Foundatio -------------------- Prop. Line ..._....__..---------- REPAIR/ADDITION(Prov. Sanitation:Permit# ___ ______ ____ I __ Date _________ ----------------------J) .I -i ----r---- ------- I` ` I Septic Tank (Specify Requirements) 50------�-r------2� --------GS C+4---- 4L-r�_�_..._ADWr_ 1V Disposal Field (Specify Requirements) �------ - w_._.Jew--- T �'V-------t-�] ,---•----------- f WA!51411V -------f'�'If LHI Aj z�------ `-------V N- --------------------------------------------- -------------------------------------- ` // ff// ,(Draw existng a'd 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,faegrulations of the San Joaquin Local Health District. Nome owner or licen- sed agents signature certifies the following: - "1 certify in the peyancebf the work foe.'v'"ich this permit is issued, I shall not employ any person in such manner as to bec ect tokman's Compensation;laws of California." Signed --- --- ms'LAA s-------------- --- ----- Owner BY -------------------------- t-R- `----• Title ------------------------------------------ (If other than owner) __ _._.. .. FOR iDEPARTMENT. USE ONLY ,._,_.._.,.+,_i---�--�'- ._ :, .«._f._. i._ �f. -.....� _.I. �_{.—:--.i, t.....�i_....._!. :_s_- 1 .� ''-.J,r.�_;_1_.._}J^ _.{M...f. -_2�� .-3- •_ i F _ APPLICATION ACCEPTED BY , - - -- ----- - ---------- { DATE)- BUILDfN�PERJ1111T-PERMIT ---- "'"" Z _�'D-A-TE--, - ADDITIONAL COMMENTS �t c= �r._;; j , --- -------- - ] a( l/ J ----- ---- -------------------------------------------- ---- ---- ----- ----------------------------- ---- -------------------------------------------=------- ;--Cft-- ------------ Finallnspectionby: ---------------------------I------------- - --------------------------------------------------------------------Date -------------------------•----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M t