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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I Permit No. '70-—��. (Complete in Triplicate) .-, Date Issued lv_��-_�.'ZO ___-----------------_------ -_--__-_----_-_----_-_ This Permit Expires 1 Year From Datesued.., Application"i'"ereby made to the San Joaquin Local Health District for a per it to.Fonstruct and install the work herein described. This application is made in compliance with County Ordinance No�549 a14 existing Rules and Regulations: JOB ADDRESS/1-OCATI7ON .__/_ �_ '�a,_ , __ --------------- f----------CENSUS TRACT --------------............ Owner's Name ----- --- _-�/''�----A -----14�f>�-- ---------------- ----- ------a--------Phone f/W- n J oe-�P-----. Address _____ � -------------------------•--. city ----------- ---------- --------�--�--+a---e--- ' Q _ Q - e - �QContractor's Name ----- ------------------------------------------- ------License -S:�� - Installation will serve: Residence A<partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other------------------------------------------- -0 Number of living units:--J------ Number of bedrooms.--_-Garbage Grinder */�'____ Lot Size ---------- Water Supply: Public System and name ________________ _--- --------------------------------------------._------------------------------------------Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe'❑ Fill Material _______:__ If yes,type -___-______--____________ (Plot plan, showing size of lot, location of system in relation to wells, buildirigs,� etc. must be placed on reverse side.) v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) W PACKAGE TREATMENT [ I SEPTIC TANK f J Size-----------------------------#--------------- Liquid Depth ----------------.------_._ Capacity ---------------- Type -------------------- Material-------------------- No. Compartments -------------- Distance to nearest: Well ------------------------------------Foundp#ion ----.-------_--------- Prop. Line ___._._.___.:.__...__- LEACHING LINE [4-' No. of Lines ________________________ Length of each line---------------------------- Total Length -___--___-___--:---------- 'D' Box ------------ AQ Type Filter Material <X, ------ Filter Material _ _________________________________ 1 Distance to nearest: Well -'17S_ ___________ Foundation --/ Property Line ...........f ---------------- Property PIT C-T Depth __ �.____-__ Diaametlr'p_xf/X`SNmbe�____-_ ----------------- Rock Filled Yes �No i❑ Water Table Depth d �_____---_ �L �'�i p --- --- ---�----------------------Rock Size -�--'-"'=�--�----------- � Distance to nearest: Well _ - - -------------------------------Foundation '149------------ Prop. Line --JF.............. REPAIR/ DITIO '(Prev. Sanitation Permit# ------------------------------------------- Date,'.. _____-_________-------._.----_.) Septic Tank (Specify Requirements) ------------- - --- --------------------------�------�==/ ---------------- --�-----.------------------ ---- -------- Disposal Field (Specify Requirements) - 4W-1 --7 1 ! -lr__h_�/1 �°� 4 r - -__ _- � - =su- . . ------------- e ! - ------ rT .: (Draw existing and required additicrfi`on reverse side) I hereby certify that I have prepared this application and that the, be done in accordance with San Joaquin County Ordinances, State Laws, and,Rules_.kpd.Regulations of the San-Joaquin local Health District. Home owner or licen- sed agents signature certifies the follo ving: "I certify that in the performance of the work for which this permit is issued,,l shall not employ any person in such manner as to become subject to Workman's CompensatiofieJaws of California." Signed ---------------------------------::------------- Owner By TitIeekl�- - gA----� r (ff other than ow --`� � - FO PARTMENT USE ONLY; APPLICATION ACCEPTED BY --- DATE BUILDING PERM)T ISSUED ----------------a. -- ------------- / ------ ---- — -----DATE - ------- --------------------- ADDI IONAL CO ENTS ----/-C1--2 __'2c7'��Gr _�o` ------ ,1- --- -- ------- - _ - ------ -'----- ------ f4 - -------- --4 =� - ---- ------- - - ------- ---- - Final'Inspection by ---------------------------------------Date -------------- ----------------------------- i �� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M