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FOR OFFICE USE: ,/ CyA PLICATION FOR SANITATION PERMIT -- 7 7 12-I f 7CJ Permit No. .-/� � (Complete in Triplicate) 141" 1"-------- J _ ----�--------�- �!f Date Issued ______________________________________ 9!/ "Ahis Permit Expires 1 Year From Date Issued Application is hereby made the a aquin Local Health District for a permit to construct and install the work herein described. This application ism co iance with County Ordinance No. 549 and existing Rules and Regulations: %� PALE Sc � F 7 DR. Ass GWEN 14SE-- Go JOB�ADDRESS/LOCATION ._' �__-_ Ql _17BT$_._ r_._ $K .j_ r�RAL-----CENUS TRACT Owner's Name _. -E7_�&L-C--f ------- ----------------------------•----------- -------Phone-7.7-rSS-1------- Address [1- ---4 r ,ir11� L ] City - _ _ .��7 µ 1 = P _ r�/� 7 Contractor's Nam ---------- / _ l S ------A----- S-e-/V-S---•---------.License # 1 067 j1----- Phone4&E?-��_�J--f----- Installation will serve: _ Residence ❑ Apartment House❑ Commercial ❑Trailer Court ',❑ Motel ❑ Other -M08_LUE____7kAJ1LE. IAVU.SE Number of living units:---I------- Number of bedrooms _____Garbage Grinder ------_ Lot Size _. ___ _S-_ _____________ 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, buildings, etc. must be placed on reverse side.) (ry NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) V -� PACKAGE TREATMENT { ] SEPTICTANIC:�1Q Size__X_�_�/n�_-� __________.________ Liquid Depth _______r,.__.._.______ Capacity/1190.(2----._-_-- Typ _ _ -_ Materiall��.- No. Compartments --2�___-------- - J, r Distance to nearest: Well �0_l _ _ _ Foundation _��Q--___-_----- Prop. Line _ �----__--_ LEACHING LINT: [ ] No. of Lines '------------- Length of each line-._-_-�Q_--------------- Total Length -- (AJ�_._------.-__ II 1 �,nnl�� it`D' Box .__ ------ Type Filter Material!-�1��"Depth Filter Material __ ___ ___ _______________________________ Distance to near t: Well —S-00------------ Foundation 440----------------- Property Line 7 ............... SEEPAGE PIT [ ] Depth _ _ No 0 Y Water Table Depth --_------- ------------------------------Rock Size -- _-- __-�- ----__--•- -_..... Distance to nearest: Well -�--------------------------Foundation -------------------- Prop. Line --------.-_---_---__-_ REPAIR./ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------- ___ --- Septic Tank (Specify Requirements)^------- ---------u----- - - ----- ---------- ------- -- -------------- A--------------------------------------------------- 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 lye 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' the performance of the work fo hich this permit is issued, I shall not employ any person in such manner as to be-c, e s bject to,.Wor an's mpensat' n laws of California.'- Signe -------- -- - -:. p'----,------ ----- •-- -- - - ------�-tk.-r ------------ Owner BY �• -C�- ----- --------- Title R ------- - -- -------------- (I other t an owner FOR DEPART T USE ONLY APPLICATION ACCEPTED BY .- - -------- ------- --------------------------------- - DATE - -3.Z ----------- BUILDING PERMIT ISSUED - DATE - ----------------- ADDITIONALCOMMENTS ------------------- ----------------------------------------------------------------------------------------------- -----=---- --.. ----------------- ------------------------ i- SAN --------- ---- ---- ------------------------------------------------ -----------------------------------------------------1--- ------- - -------- - ---------------------------------- -----�----- ----------------------- - -- --� - -------------- Final Inspection bY: E ----------------Date ----� -- ----- ------JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M (y