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FOR OFFICE'JtE: .r APPLICATION FOR SANITATION PERMIT ------------- Permit No. . _ � - - ]Complete in Triplicate) ---------=--------------------- ------------------------- - . ---------_---------------------------- This Permit Expires ] Year From Date Issued Date Issued Application is herebymade 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/LOCATION ._-- p. ---- ----'v _ ------A VE----------------- --------CENSUS TRACT ------ ------- ~ 71AS Owner's Name _ -----------04- _RTi�_R Phone ---- ` / Address -------a0-7-9------ - --------- v--E- ------ City --- 5 l -LO—Iu------------------------------------------ Contractor's Name ------ -------------------- ----------------------------- -----License # ------------------------- Phone .----------------------------- Installation will serve: Residence ❑ Apartment House, Commercial :MTrailer Goo- ur--- Motel ❑ Other ------------------------------------------- ; Number of living units:_...__;___ Numberk of bedrooms _--Garba_ge Grinder W— - Lot Size ------ .__�0-----.AC-��- Water Supply: Public System and name --- - - -----------------------------------------------------------�-----------Private �._ - - ----------- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy LoamClay Loam_❑ I Hardpan ❑Adobe ❑ Fill Materia! ._ -_ If yes,type -------..___.___-_-----___ (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 publics sewer is available within 200 feet,) Q PACKAGE TREATMENT I ] SEPTIC TANK'f I Size---- --X___/___ ------------ Liquid Depth ____ 1 - � . Capacity __. � -:-- Type ��_I"_•1�_ _ Matpriu!___�0ttifr'-_�'_____ No. Compartments --- �.. istance to nearest: Well _________5<2___ _________ _____Foundation ----- -- --- --- Prop. Line ------- LEACHING -____LEACHING LINE [ I No. of Lines ------f._-------------- Length of��seach line------- Total Length ______-;510--- ------ - 'D' Box -� Type Filter Material __'Ro K Depth Filter Material ____---_ ___-_E____________--------- Distance __Distance to nearest: Well ---------/pa_____ Foundation -1— --_� __________'"'".Property Line __________________ SEEPAGE PIT _a po' th `itz----_.____ Diameter --- Number _____-l----,1-1:- =-:Rock Filled Yes o r [�! p v•u . Water Table Depth --------------------------Rock Size --- Distance -Distance to nearest: Well -----------------1490__`---------.Found tion„_._-_---/0._._ _ Prop. Line _.__----------------- REPAIR/ADDITION(Prev, Sanitation Permit# --------------------------------- ---------- Date --'--------------_------------_i--1 Septic Tank {Specify Requirements) -------- ---------- ------------------------------------------------------------------------------ --•----------------------------- Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------------------------------- ---•----------- �.!-, ------------------------------------------ -----------------------------------I---f---'-------------------------------------------------------------------------------------------- -------- :. I - - -- ----------------- == = = —. -- _:- ,(Draw existing`and requ.ire'd addition on reverse side) I hereby certify that I have prepared this application acid 4hiat 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: f(moi ;T "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 become jest t o kma 's C mpensation haws of California." �. Signed --- - -- - �� Owner By --------------I------'-------------- ------------------------------------------ir -----------_ _ Title ----------------------- ----------------------------- ------------------- `(If olhbr' thar( owner) 4. t "'FOR-,REPARTMENT USE ONLY APPLICATION ACCEPTED BY _ t- - _--- f DATi `=. t ` s;---------------- ------------ ---- -- --------- - - -- BUILDING P>_RN11T'ISSUED - T_�. ---r._ -- '-�==-T----____:_ DATE-. ------ ADDITIONAL COMMENTS __ L: r= ` ' } ;f == -- �'-- ---- --------------------------------------------------- .M_ ry .—.. _ — - - - _ - - ---------------------------------- ----------------- _ ---- --- - --------- ------------------------------------ -------- ------------------------------------- t -------- -- E Final Insp b : ---- - - ✓ - - Date - SAN JOAQUIN LOCAL HEALTH DISTRICT ( E. H. 9 1-'68.Rev. 5M