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FOR OFFICE USE: ^i APPLICATI SANITATION PERMIT ------------------------------------ ---------------- Permit No. -- ---------=-------------- 1 (Complete in Triplicate) ------------ -- ------ --_K----------------_____-______ This Permit Expires 1 Year From Date Issued Date Issued _�.-_�--q-_7 Application is hereby made to �A ROS L'6 Ir a .permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and and Regulations: Z &T-T-F 641 �T JOB ADDRESS/LOCATION .---- 8 _- ----------5tz:_- ---- y -- - - / WA `A' -: --- -� CENSUS TRACT - J__ Owner's Name ----- / yh � _j ----------------------------------------------------- 21 Phone .-�------------------5y--6-�-6 Address f � 7__sl � ------ � ---------- CitY � _eAIC _- Contractor's Name X = ` _ Phone �--a� Lic Installation will serve: -Z- --�----' -- Residence M Apartment Housef] Commercial ❑Trailer Court Motel ❑Other ------------------------------------------- Number of living units:__________ Number of bedrooms ----Z....Garbage Grinder _________ Lot Size -- 8o_�'-___ �� - ------------------------ Water Supply: Public System and name C19_R_Did_Z_ A______VI Ll�_________��-'QLI�_ ��ATE1�_ _ Private ❑ Character of soil to a depth of 3 feet: Sand' Silt CI ❑ ❑ ay ❑ Peat❑ Sandy Loam .RL Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot _-_________-_________(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) flD NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V PACKAGE TREATMENT [ ]' SEPTIC TANK ( Size___ _ ✓sir ----------- Liquid Depth ----9-------------------- Capacity J-17"'_a------ Type f`?__63!;?Material_____ _e_ � No. Compartments __ _____________ Distance to nearest: Well XY`7 --'- -- ___Foundation -___/0------------ Prop. Line ____.c :..__.__.___ ' -------- ^�- LEACHING LINE No. of Lines -------- Length of each line-----7_0-------------- Total Length ____� � ------------------ D' Box ----- ____ Type Filter Material Depth Filter Material -------X0. - Distance to nearest: Well -__!Q --'f'_ Foundation ---------».--------- Property Line _ _________•___----_- SEEPAGE PIT [ J Depth -------------------- Diameter _ ______________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------- Distance to nearest: Well ___-________________________________Foundation -------------------- Prop. Line ---_----------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ______-______-____.-_____________-) /-z-9-7/ Septic Tank (Specify Requirements) ..SLGiSZ ►�!_--J.nIST3L,Lp_ { � RT� Q, Disposal Field (Specify Requirements) __-_________ --------------------------------------------------------------------------------------------------------------- -------- ----- --------- ----- -- --- - ---------------------------------------- - ------------------------------------------------------------------------------------------ (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 By ----------- l/6 Title Lfp-!1 ` ---------t> (I other t an- ------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_----- ------------------------------- -----------. DATE ----- "_2_7-'--7,/ BUILDING PERMIT ISSUED ___-_ - --------' ADDITIONAL COMMENTS _ >-____ - --------------------------------------------------------- ---------- ---DATE ------------ ------------------------- i ------------------------------------ - ,1 -- ---- -- ------ ---- - -- - --- ---- - ---- -------- ------ - --- - FinalInspectioYDate O I � �-- - -- N -- -- - SAN JOAQUIN LOCAL )�H DISTRICT E. H. 9 1-'68 Rev. 5M