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A FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT- - --,-----1'�-'3.- - - Permit No. --------------------- (Complete in Triplicate) - Date Issued __�'�-S-"7z __ This Permit Expires 1 Year From 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 madelin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----------A4;:P_C1,_-775_A1----------------- TRACT -------------------------- Owner's Name -------C:------ zEZSL------------------------------------------------------- ---------------------Phone�_�sZ _�-7- Address ----- 7 i;�.�1 ��- ------------------------------------ Cityll/- -4 ---------------------------------------------- Contractor's Name 6e, - ------License # 45VIZ3--- Phone Installation will serve: Residence `Apartment House❑ Commercial:❑Trailer Court -,E] Motel ❑ Other -------------------------------------------- Number of living units:---y---- Number of bedrooms __Z�n---Garbage Grinder ------------ Lot Size __ f_- 6 ----r------ --- Water Supply: Public System and name -------- - Private ❑ it a depth of 3 feet( Sand' Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Character of so to p t ❑ ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type ---------------------------- NJ t (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,) t PACKAGE TREATMENT [ } SEPTIC TANK'[ Size--------------------------------------------- liquid Depth ---------------------.-.--- x�5T�9 Capacity 1-------------- Type -------------------- Material----- ---------------- No. Compartments -----------------_.- Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ------------_--.------ LEACHING LINE [ ] No. of Lines -------/-------------- Length of each line_____ __----____ Total Length ----- 7------------- 'D' ---7---_-_--.-__- 'D' Box -4 rA60.-- Type Filter Material _/p- _X/--Depth Filter Material -_-,1 =____---------_ .. ,,/ Pro er Line Distance tonearest: Well --�1- .�__ Foundation __��--------------- P ty •-•- -----••--- SEEPAGE P17 [ ] Depth ------ Diameter _-- __ Number -------- ---------------- Rock Filled Yes to r Water Table Depth--------------------------------Rock Size _,:'IX-�/� --•---- r Distance to inearest: Well ..-- _4�------------------Foundation ,_. /. 0---------- Prop. Line -�----. -------- t REPAIR/ADDITION(Prev. Sanitation Permit# --------.----------------------------------- Date ----------------------------------) SepticTank (Specify Requirements --------------------------------------------- ----------------------------------------------- • ------------------------_- : 10 1 Disposal Field (Specify Requirements) - - ---� ---- 1 � 7-- f �f---------- ------ --- - j x1,T�y1EC77--- - - -._-, - ,r.S = -------------------- ----------------------------------------------- j( row 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, an;d 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, 1 shall not employ any, person in such manner as to become su *th p's Compensation laws of California." Signed -..------ ----------------- Owner BY - ----------------------------- Title -------------------------------------------------- (If otr) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---`C' ------` � ' -� - --------------- -------------------------- DATE �� 7 BUILDINGPERMIT ISSUED ---- ------`�---- ------------- -------------------------------------------------------------------- DATE ADDITIONALCOMMENTS ------------=-t------------- -- ------------------------------ ------------------------------------------------------- -------------------- ---------------------------------- I " t -----=-- Final Ins ection b �_ -------------Date ----- --- ---- - -=-- P J-Y Y �P SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M