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` ,V1 .FOR OFFICE USE: `:. A _ .-KATION FOR SANITATION PERMIT ------ ------------------=------------------------------ Permit No: -73_�_�� 1Complete in Triplicate] ---------------------------------------- _.------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATIONzlovet______f �fc CENSUS TRACT __________________________ Owner's Name , ------------------------ Phone Address --cZ3-0o____ �G�.rslE 1 % �1f�xz/ ------------------- City ��' - Contractor's Name ____ �e u�_ .c� -----_----------License 7--?__ Phone _ 43'A.0 Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Motel ❑Other -------------------------------------------- Number of living units:------------- Number of bedrooms .__________Garbage Grinder ___________ Lot Size ___ __5 _f:________________ Water Supply: Public System and name ---------- -- -------C -- --- _ ------------------------------------------------------------Private,_ Character of soil to a depth of 3 feet: Sand'0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 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.) l.r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE XREATMENT f ] SEPTIC TANK f ] Size------------------------------------------------ Liquid Depth -------------------------- W . y�j(CS 1i��G1 Capacity -------------------- Type -------------------- Material---------------------- No. Compartments -------------- --•-- V Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ----------------- LEACHING LINE [ ] No. of Lines _______________________ Length of each line Total Length -----------._______.______._ 'D' Box ------------ Type Filter Material ____________________Depth Filter Material -_________________________________________ Distance to nearest: Well ________________________ Foundation ---------- -------_ Property Line ----------------- ...... SEEPAGE PJ7 s[ ] Depth _____ Diameter __-Oxf------ Number --------!4t-------------- Rock Filled Yes No rX/S ., cf Water Table Depth --------�'__S� _________Rock Size � Distance to nearest: Well ------� �--------------Foundation --1C.2 Prop. Line ------------ REPAIR/ADDITION(Prev. Sanitation Permit# _____ ------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------------------------------�------------------------------------------------------------------------------------:----------- --------- A rfftposal Field (Spe 'fy Requirements) ______ ,CIf`-______/_______--s-__'Al_./40-- V S,7!_k Ae J r' �! ecle�e .�f_SSCS ------------------------------ rs�-,dam----- / /<l�f ----- ® (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 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, I shall not employ any person in such manner as to bec a object o rkm .n's Cpensation laws of California." Signed - ------- - ------------ - -------- Owner $Y -t' (--�� title .. ' ------------------------- - (If other tha nwne F DEPAitTMENT USE ONLY APPLICATION ACCEPTED BY ----------- -- - 1 ----------------------------------------------------------------. DATE -- 0 = ----------- BUILDING PERMIT ISSUED ---------- --------------DATE ------------------------------------------- ---- ---- ----- --- --------------------------------------------------------- - ADDITIONALCOMMENTS --- - --- ---- ---- ------f------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ----- ------- ---------------------------------------------------------------------------------------------------- -------------------- ---------------------- - - - -------------------- ------------------------------------------------------------------------------------------------ ---- Final Inspection by: -------- - ------ --------------Date --- �=� ----- --- -- - - - - - - - - - - - ----------- ---- SAN OAQUIN LOCAL HEATH DISTRICT E. H. 9 1-'6$ R . 5