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FOR OFFICE USE: { APPLICATION FOR. SANITATION PERMIT ............. I (Complete in Triplicate) Permit No. ...-7....�a This Permit Expires 1 Year From Date Issued Dare 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/LOCATION .:2i.Z�.3."4.1�...__.F,--.--•--.R_L\IE-P�. -=----.R.�..-...---._...................CENSUS TRACT .:.......`.� ::.:.. I' Owner's Name i ---........�[_\i.�.��_.._._.._�_��-�-:�.�..Q...-•---•...........................:........:............Phone ,..-.;............................... � Address .. . F--- r' C . t .9 _.. _ Cary ... .... ................... Contractor's Name ......._.0-1E41VaP- ---------------------------------------------------------License # .... Phone Installation will serve: Residence Apartment House Commercial E]TrailerCourt 0 Morel ❑Other ..... ......... ............. Number of .living unit s..--/ Number of bedrooms _.. .:_.....Garbage Grinder Lot Size . _ tir�.......... y Water-'Supp`lyi-Public System and name ..............................---------------------------.....................••------------------------'-:..Pirivpte®� Character olNoil:tola depth of 3 feet• ;Sand Si Clay ❑ Peat❑ 'Sandy Loam qrll-646a Loam'] Hardp�gp —Adobe ❑ Fill Materia! .. .. . . if yes,type ............................ 1�r Plot pplan, showing size of lot, location of. system i relation to wells, buildings, etc. must be placed on reverse side.) f_MEW INSTALLATION: (No septic tank or seep pit permitted if public sewer is available within 200 feet,) <'.PACKAGE TREATMENT [ }. SEPTIC TANK ................ Liquid Depth ..... .................... �1y Capacity TypeRF—CAST.`Materia! Compartments ...... W Estance to nearest.• Well ; ,..t��.+ ~ PJ"fi`' Pra line�'.. -.Foundationw.:/ p:' _-_ rt LEACHING LINE . [W/No.. of Lines ...._...`�F.._.....1... Length of each line.______._; (.....Tota! Length ......rZOV... .•. � . �'D' Box 5. "1"Filler Mat tial = _ G l _Depth Filter Material ........... __R_ 4................... 014" Property Line ..._--.-•------ Distance to nearest: Well .......;��.,+.. Foundation _. _. I SEEPAGE-PIT -[ Depth--nn _._ tDiameter4 .. !�. Number ..._...2 Rock i=i led Yes' No ,%'� ` Q Water Table Depth :---- -............... ........Rock Size Distance to-nearest: Well .......� Q•_----__�.._____...Foundation ._._ �.... . Prop: Line .€.., . __..�! ;_... i f REPAIR/ADDITION(Prev. Sanitation Permit# ............ Date )_. { v Septic Tan (S.pecify Requirements) ---•------ ----------------------------- ..........•.....................:..::7:...................... ._:..__..._............ ,rl 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 Hea_ lth District.-:Hame owner or licen- sed agents si ture certifies the following: "I certify th he pe armanc a work for which this permit is issued, 1 shall not employ any person iw'such manner as to beco ject t orkma ' am Ilan laws of California." Signed ..-- Irk. . . . _ ..,.�. ........................ Owner;" � _ . Y 8y ...................................................:...............-•----•---------- _` � � Title :....._.._........................ .................. .........� (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . - --r-tRA.0Q - _1 ........::� DATE ...... BUILDING PERMIT ISSUED ---------- •. —------- t * F"..`-.....-----DATE _.._.....-- ............. ADDITIONAL COMMENTS :_.• ``._ ............................... .......................... ........................ . _ f . ... �- �. :. ...r.'...... . -..._.._........ . ...--•--•-•-...--------.----•---..-...._----•---•----•---................ ..................o , ... r_. ....... ......._.....:_............................... _ �Final Inspection Date .. .. SAN JOAQUIN LOCAL' HEALTH DISTRICT -73 , E. H.Z3 241-'68 Rev. 5M r A V 7/72 3 .K �'f