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FOR OFFICE USE: (� - APPLICATION FOR SANITATION PERMIT r c Permit No: -7U "----- -7\A __.._ (Complete irrTriplicate) _------_------------___-_-------_---- 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/LOCATI __2 -io-.,�.------61-R--PD_FZT-___________/�'(_1_-CA. CENSUS TRACT ___5_75V___._.. Owner's Name --------_J-6 H--fj----------RQ Q�---------------_----- --------------------------- ----------- --------Phone ------------- ................... AlIT Address -------- -f53-�------- 5---------f-R_P_- T---------------- --- City --- 64-'--------- -------------•-_-- ..................... Contractor's Name -- _EDWALEK------------------------------------------------- --------License # ------ --------------- Phone ---------------_----------_ Installation will serve: Residence ffrApartment House❑ Commercial [-]Trailer Court '[I Motel;❑Other -------------------------------------------- n Number of living units:-.--/------ Number of bedrooms;3------Garbage Grinder -- . !_ Lot Size ----------- Water Supply: Public System and name --------------- ----------------------------------------------------------- ----------- -------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑//��r,,Sandy Loam t�Clay Loam ❑ p Hardpan ❑' Adobe E] Fill Material --- -- if yes,type -------------------- ____ 1�► (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,) W PACKAGE TREATMENT [ ] SEPTIC TA,NK [ ] Size-----------.;__---------------------.------------ Liquid Depth -------------------------- Capacity------------- ------ Type -------------------- Material-- --------------- No. Compartments ---------- ........... Distance to nearest: Well ------------------------------------Foundation ___ _._ __--_______-_ Prop. Line - ........... LEACHING LINE [ ] No. of Lines __:_____- ________ Length of each line :._________ ----- Total Length --_-_-____ __.1_--------__ 'D' Box ________ Type Filter Material -____---_-___;._.,Depth Filter aterial ___-__.________.__________________________ Distance to ne rest: Well --------- ---------------- Foundation --------______ ________ Property Line __-_____-_-_-___--._--_- SEEPAGE PIT [ ] Depth ____________ ------- Diameter ---------------- Number ------------------- --------- Rock Filled Yes ❑ No ❑ t WaterTable th ------------------------------------------------Rock Size ----- ------------------------- Distance to ne est: Well ________________________________________Foundgtion _,_---_____--- Prop. Line _____...___.._..._.... REPAIR/ADDITION(Prev. Sanitation Per i## —----------------------------------- Date --------- Septic Tank (Specify Requirements) ---- tqLp)-1- --- .__ X)ST1_A� :---c _Pt1 --- y5Nt Disposal Field (Specify Requirements) ' ____R. M_ L Rte - ► vo GAS. cacKT"� �R -F/� - btT- aX = 2--------- ` x -_W_j-D-�------1-EACA-----t-►-_N�-------------KuTcHEn/._ �-9_u_N_11 R_ ------------------------------------------------ (Draw existing and required addition on reverse si ej-_ 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 HealthDistrict. Home owner or licen- sed agents signature certifies the following: "1 certify at in t perfor nce of the work for which this permit is issued, 1 shall not employ any person in such manner as to bec e s Iect to Wo an's Compensation laws of California." Signed - -- --- ------- ----- ---- --- �8 ------------------------------------------- Owner By --- -------------------------------------- ----------- ------�,.A!O--------------- Title -------------------------- --------------------- - -------------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------71�)-R� -------------------------------- ------------------------- DATE -------- BUILDING ------BUILDING PERMIT ISSUED --------------------------------------------------------------------------------------------------------DATE ------------------------------------------ ADDITIONALCOMMENTS --------------------------------------------------------------------------------------------------------------=------------------------------------------------ -- - - - -- - - ----- -------- -- ---- ---- -- ----- - --- - - --- - - ---_ ---- --------- --------- --- -- - --- - -- ----- --------------------------------------------------- Final Inspection by: --- ----- _ _.J�c r�i_ ---------Date - .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1' E. H. 9 1-'68 Rev. 5M