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w Y FOR OFFICE USE: APPLICATION-FOR"SANITATION PERMIT ----------------------------------- '�/ (Complete in Triplicate) Permit No. r " Date Issued __�_-_Z_9- 71 __-___________________-_-________-________-_______ This Permit Expires 1 Year From Date Issued Application is hereby made to the A permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and and Regulations: JOB ADDRESS/LOCATION ------ _7_ _ ___________5 --__h` �' __ax _-_ 'g y --�---- ---- ----------- CENSUS TRACT -----5 Owner's Name ---------- -----� �-- _-------�-- -- �Y�/If �,,3.Z 3 -- n- --------------------�---------------------------_-�-------------------Phone ------------------------------------ Address ---------A-/-�/--------f�' 3 9 .---�}/ ----------------- Cit �A Y --- ------_---•-- Contractor's Name _______ _____ ___se_ ___-_•-,_____.License # g�'-S�� Phone _ 3_ _� 1 Installation will serve: Residence ❑Apartment House,❑ Commercial [-]Trailer Court l❑ Motel ❑Other -------------------------------------------- Number of living units:________ Number of bedrooms ---A-----Garbage'Grinder ____________ Lot Size ----------- .......... Water Supply: Public System and name CR_1X ------- 1L ----- •'tk�( __._k+° T )-----------_-----Private ❑ Character of soil to a depth of 3 feet: Sandbe Silt F] Clay F] Peat Sandy Loam J® Clay Loam E]Hardpan Adobe E-] Fill Material -AV--- If yes,type ____ __________ J S (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) \4 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT .SEPTIC TANK� Size----- � ------------ Liquid Depth ---------------------- Capacity _� d_Q__--- Type P',,- -71 No. Compartments __�_______________ Distance to nearest: Well -----!1e------ ---------------Foundation ____l_b----------- Prop. Line --r__-_____._...______ LEACHING LINE No. of;Lines -------2�Z--------.__ Length of each line____�d-------------- Total Length ,_1_y1�---------------- I D' Box ____/_____ Type Filter Material 1z_ P_4_fi:Depth Filter Material _-___ --- Distance to nearest: Well ----- Foundation ________1 ___________ Property Line ---------------- SEEPAGE PIT [ ] Depth` ________________ Diameter ________________ Number --------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------- ---- ------ RockSize ._------- - -- ------ Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line -----___.......... REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ---------_------------------------) Septic Tank (Specify Requirements) _____-_S_i=_PTI_ ---_ �-r -n�______I_NI_ST_H_�t„1 _____ _1�U1!-1.NC-__N _____-"1_f ` Disposal Field (Specify_Requirements) _---�_'-R"� �9-7� --------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------------------------ --------------------------- - ------------------ ------------------------------------------------------------------------------------------------------------------------ (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 become subject to Workman's Compensation laws of California." Signed ------ -- ---------- -- - Owner Title ------- o�Y �s -�----------�--------------------------- BY ----------- s �F� - = C / (If other than o FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------717 _K_0 ----------------------------------------------------------------- DATE ----7:7127--,71 PERMIT ISSUED --------------------------- - DATE --------------------------------- ADDITIONAL COMMENTS - - I---- ----------------------- - ---------------- ------ ------------------------------------- -- - ------------------------------------- --------- --------------------------- --- --- ------------------- ---------------------------------------------------------------- ----------------------- ---------------` -- ---- --- - -------------- ------- -------------------------------------------- -- --- - - ---- ---- Final Inspecti -=Y -�' --- G--- ----------------------------Date ----- --- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M--