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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIlt r IComplete in Triplicate).......... ...................&_......__....... ........ _ Perm€tlo .t� This Permit Expires 1 Year from Date issued Date Issued •3-S 76 Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install described. This application is mode in compliance with County Ordinance No: 549 and existing Rules and Regul tionsrein •31 � i� JOB ADDRESS/LOCATION t-2�d iurn ..Dr.............. ....._... CENSUS TRACT Owner's Name ...... F_172 - Phone Address Contractor's Name .........................................R_. . ............-__-_-- ----- - - -�— - - ........................License #27153.9.......... Phone .65-2616 Installation will serve: Residence g]Apartment House 0 Commercial❑Traller Court f3 Motel []Other---,............................... Number of living units:l.......... Number of bedrooms ___.�-..:._Garbage Grinder _yes 0 b 1QQ Lot Size -.5--••-•--y••- -••••-•................. Water Supply: Public System and Warne Calif• mater Ser: � -- ..... - ............... -`-...._.................. . .... ... .............. ....................................Private Character of soil to a depth of 3 feet: Sand r] Silt❑ Gay ci. . Ped-t-0 Sandy Loam fl Cloy Loam ] j Hardpan 0 Adobe 0 Fill Material ............ If yes,type............... ............ (Plot plan, showing size of lot, location of system'ln relation to wells, buildings, etc, must be placed on reverse side.) { NEW INSTALLATION: (No septic tank or seepage,pit permitted If public sewer is availoble'within 200 feet,l I PACKAGE TREATMENT [ } SEPTIC TANK3 ., Size_4_'.5._.. r by 9' --. Liquid Depth .................. acstY 120-0---------- Type -Pa_fo_rmAkbteriaFi.be_vg1_w3,s � No. Compartments 2 Distance to nearest: Well n�a ..Fo�rr�d[ation 10 .................... ------------- 4N s 1 ......--••-...-_-••-_. Prop. Lige LEACHING LINE [x] No. of Lines _. Length of each sine------ '�"Of .. .. ----------- ...... _. Total Length ••lfi. 'D' Box np........ Type Filter Materlalr-o.ck...........Depth .Filter Material _.• -8'� Distance to lanearest: Well �a ff _.....�oundatior 10 ' 5' "'...-XS V x Property Line --t J SEEPAGE PIT . .Diameter -------_--_- Number ................ . Rock Filled Yes E] No C [ . Depth ................ .. Water table Depth -•-_--lip-f_----.---•_----- -Rock Size .... Distance to nearest: Well ... 5 r n/a-__.__.. Foundation Prop. Llne ' 3. --- •-•-----•---•• 3 - x REPAIR/ADDITION Wrev. Sanitation Permit# .......................................... ------ Date ................. ) ............ Septic Tank (Specify Requirements} -- Disposal Field (Specify Requirements) ............. nly _re Pair pos s ible at this time two huh cesspools on - - -------• - g p property•were -�'iT1e:d---�-o"r---s-afety:"--------------..........--................ . ----•------•----------------•-••----- (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 t 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 worst for which-this permit is issued, 1 shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." Signed --------------- --- Owner i BY --- --- - -- ------ ----- _ Title _-.. ----------- ---- Cantra�tor-------- .-..--._ .. (If o#her than owned .............. FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY__ --- BUILDING PERMIT ISSUED ------ -- ---- DATE r,3. 7'. :� ---------- ADDITIONAL COMMENTS ---- .......................................DATE --..-----•-----•-••-----• --..._._.. " _ -----------•--"--------•-••------••--- ----------•-•-•-•----- = F -----------_--------__________"__--__-.... Final ins ection b _....._. _._._.`.-..._ EH 13 24 1-68 rev. 5m SAN JOAQUIN LO AL HEALTH DISTRICT 8/7h 3M �d