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4:s a. ! FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------I---------------------------------------- (Complete in Triplicate) Permit No: __— II _._._._._________________________________________:..... This Permit Expires 1 Year.lxrom bate Issued 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB �iikRESS/LOCATION)'-J-3_ j-$2, S ... _� Q-0_1_N-��_�_.i�t_.. .-------- ---_--CENSUS TRACT ---��- -- -� ...... Owlmf ,,lNar�ii e FR)9N_K_ - 1 W ------------------------------------------------------ --------Phone ------ Address ----- ------ - 1 _ t_�1------------------------------ City ----- ---------------------------------------- Contractor's Name -F-----PLPA_Ay,—A -, License # :.. Phone Installation will serve: C -Residence ❑Apartment House^❑ Commercial [-]Trailer Court ;❑ Mo-tel Other ---T-- I------------ ------ I � Number of living units:____:_)____ Number of bedrooms __Garbage Grinder �(---_._ Lot Size 4C•(�EA&�- Water Supply: Public Syste and amem ------------------------------•---------- -------------------------------.__---------•----------------------Private Character of soil to a depth of-3-feetSand [] S' Clay.❑�Peat❑,Sand. -Loam..E].; -Clay-Loam-O. _ .y Hardpan .-.Adobe e❑ Fill Materiae--_-----_ If yes,type __________________ _________ (Plot plan, stowing sizeeoof lot, location of system in relation to`,dells, buildings, etc. ust be played±on'rev se side.) W NEW INSTALLATION: (No septic tank r seepage pit permitted if public-sewer is availa le within 200 feet,) y PACKAGE TREATMENTS j[=13�4(SEPTIC TA K:[ ] Size-----------------%_E---------------_------ _____ Liquid Depth_-------------- Capacity ___________ ------------ p Y Type o. Compartments. ____.....___ Ca acit : T e Material,--------------- Distance to ne rest: Well ________-I__.-__-_____--_:_________Foundation _____ ________________ Prop. Line ______________________ j LEACHING LINE [ ] No; of Lines — ---_---____ ________ Length of each line-l'-f_------------ -_- Total Length I ----------------------------- 'D' Box ----------- Type f=ilter Materl -------- Filter aterial ------------------------------------------ Distance ------------------------ --_--- Distance to ne rest: Well _____________________ Foundation --__-________. _____ Property Line ;. � - ------------------------ SEEPAGE PIT [ ] Depth _-___.-____ -._--_ Diameter ________________ Numbei.}______ _._._-_--__-- ------- Rock Filled Yes ❑ No i❑ _ Water Table pth ------ ----------- -----------'--'--------Rock Size ------- ------------------------ --Distancel,to a rest: Well ---------------'___*-_________'___.___Foundation -- -------------- Prop. Line --------------....... . REPAIR/ADDITION(Prev. Sanitation t# ---------_----- ---�___---i__----- Date'F------------- ------------------} Qis sal Field (Specify Requirements) J�1,ST----'�-JCC°------�� ------' �---='---------------- ------------ --------,..-----------------------..._ i Septic Tank (Specify Requirements) ---------------------------------- ------------- p f P Y q If7`�-�lv------Un Dj6a4 -----A ARIVR�W 6 X11✓ -----------59�1�A��----` p/ `k " ' ' X- --------------- _y -------------- ---- ------- ---- ------------------------------ . ----------- ---------------------- (Draw �. _ existing and required addition on re terse side) , I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the fowing: F "I certif t n the rmance the work for which this permit is issued, 1`shall not employ any person in such manner . i,r„ g � km 's Compensation laws of Californias Signe ne to bec a sub'ec to or � !Owner - - - -------------------•------------ Owner B f Title Y ----------------------------- - - --- - ----------------- r (If other than owner) S FOR .DEPARTMENT USE ONLY } APPLICATION ACCEPTED BY ----- t BUILDING PERMIT ISSUED '°------------------- --------------- - ------------------------------------ ---DATE -------------------------- ADDITIONAi,COMMENTS = = ----•--------------------------------- ' .;_ -- ------------------------------- -- ---- ��- Jn j.:� R : . --- - ----- ---L - { '_-__, i Jy_a �_ C_ I _ i_s J - __ ___._ ---- _ ______._________________________________ _ ______________ ------------------ -----------------" ____ _- lrrspectr �. Date- . --- -------------------------------------------- Final 7 SAN JOAQUIN LOCAL HEALTH DISTRICT ,f E. H. 9 1-'68 Rev. 5M n