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FOR OFFICE USE: l� Y / APPLICATION FOR SANITATION PERMIT P 5 S ICotnpiete In Tdipllcate) Permit No. .7.7..._.�_T... ..............: ........-----------:.......... ::.•_:...: - . ......:....................................I............. This Permit fxpires 2 Year from Date Issued Date issuedS-77 t ' Application,is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein described. This application is made in compI a with County Ordinance No. 5.49 and existing Rules and Regulations= JOB ADDRESS/LOCATION .... ... • ... ........I.................� ......:. .......................CENSUS TRACT ......:...... ............ Owner's Name ................ ------s........ . :.......f. ....... ..,............. .....:................Phone ..�® Address . . ... ....... . v . .. ........__ ....................... .. j� Ci Contractor's Name ._._ V. ... = .d .... Phone Installation will serve: Residencepartment Housefl Commercial pTrailer Court :.......:......... I f Number of living units:.__- ----- Number of bedraoms�...__Gar a Grinder .....,..... Lot S ..1 ..........`... _ .. .................... ....... ........................PrivateWater Supply- Public System and name .... ❑ Character of soil to a depth of 3 feet: ` Sand❑ Silt❑ -4Ciay ❑. Pe9t 0 Sandy Loam 0 Clay Loam ,,Hardpan ❑ Adobe A Fill M4teriol ............ If yes,type ............... ............ ` (Plot plan,, showing size of lot, location of system in relct#on to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage p t permitted If public sewer is available within 208 feet, PACKAGE TREATMENT SEPTIC TANK f ] Liquid Depth Srze......... • ............ Capacity ...... Material................... No. Compartments ..:................. !"' ---------------..... Type .............• Distance.to nearest: ,Well ........................------------Foundation..................... Prop. Line ...................... OQ LEACHING LINE [ ] No. of Lines ------------------------ length of each line---- ................. Total Length O ' 'D' Box ......_.-__. Type Filter Material .......Depth .Filter Mateiial Distance to nearest: Well ...-------.-`._P4- Foundation ........................ Property Line ........................ , n ' SEEPAGE PIT .[ ( Depth .................... Diameter Number --------...........-........ Rock Filled Yes ❑ No ❑ v. ' Water Table Depth ............................ ..............Rock Size ....._...........•---.:......... J Distance to nearest: Well .................: C ---foundation ............:.... .........-•-•-•---- --- Prop. Eine ...................... � REPAIR/ADDITION(Prev. Sanitation Permit .............'......... Date I Septic Tank (Specify Requirements).--- --- -------- --1 ....................... ------------------------- ............................................ Fiend Specify Re irements( _-.J --.•. - ----:- -...... f .. . , .. ...... ... . .... 3-" -- ...........................................................•- : '------ ---- ---- - - --------- _ f©raw exi Ing an required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be donei in actordance 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 Fedlormance of thew rk for-which-this permit-is-issued,-I shall-not-employ any person in such manner as.to be a su orkm 's Comp cation I of California." Signet! __.. __..._�.._ .L-- --------------------.96~.._ ._.. _ - ------ •--•- --------------WinrNLY: Y --- ------- ----------------------------------------------- ------- --•---•--------- - .. B. Yitler -.................r�.....-- (If other than ownerl (/ / FOR DEPARTMENT' USE APPLICATION ACCEPTED BY Y- - - . .--- -----BUILDING --- .. ---- . DATE �._5......_....-•---•- - -•----ERNIT ISSUED ... DATE. , - ----- --------------• --- -- -- ••-- - - ---•--•----- -------..-_------•---•--•---ADDITIONAL COMMENTS ------------------ - - ------------- - ------- .�, . -•--•---- --------•--_. .............................. . ........._.._.-.-_.--. -------------- ----• ..-----------•-•._-...._....... -- Final Inspection by: --- .� � _._ Date ..�..j EH 13 24 1-68 Rev. 5M � �.. ................ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M