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FOR OFFICE USE: f APPLICATION FOR_,SANITATTOt�1 PERMIT ................. ....... Permit No. .. -7 .Z T (Complete in Triplicate) ...................................................... �i73 This Permit Expires 1 Year From Date Issued Date Issued _.4......... ..... 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. 544 and existing ,Rules and Regulations: JOB ADDRESS/LOCATION :...1632-3-..F.,-.Hidav----26............... ...... ...............................CENSUS TRACT ....................... ZZ Owner's Name ... ?.,8...�......��1 ex'o: .........:..: - ... fir, :._.... Phone:..... .....--•- .... ...... Address ._._._ . 2.�1..E.,.Milton City ...Stkn....... •-------------------------•-----------•--•• -•-•-----.------. -._........................-•-••------•-----........... I` Contractor's Name ...............................License #-----268.53-.._. Phone _46_3ri.?.0.44'1........ Installation will serve:- ---Residence Q Apartment House Commerciai []Trailer Court ❑ Motel ❑ Other .............. .......:.. ...... • 1 r h !, r „rte Number of living units------ .... Number of bedrooms ....3......Garbage,Grinder .........__- L-ot Size 100_._l.cre ..................... Woter Supply: Public System and name ......:----------------•............-..........................................................................Private II Character of soil to a depth of 3 feat Sand ❑ Silt❑ Clay`, ❑ ' Peat Sandy Loam (a Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material'n. ;,.... ktyes,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 public sewer is available within 200 feet,j., PACKAGE TREATMENT j ] SEPTIC TANK k] Size_`__._._.6 X7 X1 f............... Liquid Depth _:_..56............. --r Capacity 1200 ..........St1...:. Material con_..--------•-- ' p y .................. Type 'No. Comportments- ....Z.. U, Distance to nearest: Well ------5.Q'..____:........:.... Foundation .....:....1.Q.'...... Prop. Line ........ LEACHING LINE [� No. of Lines -------- -------------- Length of each vline--------6�V*......:... Total Length"��0................... W 'D' Box ....I...... Type Filter Material .........._ 1".._Depth Filter Material .......19 .............................V Distance to nearest: Well ._.._...5....._... Foundation 20' . Property Lina 5.. r SEEPAGE PIT Depth ...... ....... Diameter __.3)...... Number .............2_.......... Rock Filled Yes [3 No ❑ Water Table Depth 0 == ........Rock Size . 2••....•••--•----•------ s ..e :.�7 I� Distance to nearest: Well----------.-�-0fl�..................Foundation ....b0 ..... Prop. Line _34±ft.R:k....C�,: f ° f REPAIR/ADDITION(Prev. Sanitation Permit�# ............................. Date ............................f_.) Septic Tank (Specify Requirements) 200" Leach Line &- 3-33"X250- Pits ._..._.. r Dis oral field (Specify Requirements) ........... .....................................................---------------_...............:............................................_........ (Draw existing and required addition on reverse side)-` I hereby certify that I have prepared this application and that the work will be don;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 become subject to Workman's Compensation laws of California." i Signed ........ -------------•--------- Owner I - - -------------------------- Contractor ---- --------------- By .._.._.. _., = - -•_. .... � �a"NT ...... Title .......................................... I (if other than owner) { USE ONLY tJ APPLICATION ACCEPTED BY ..... ....:. .... ........, DATE ..... .. ... ... ... ..... .......... 1 BUILDING PERMIT ISSUED ..DATE ........ ... .............. ADD TI ALC ENT . • ---- •. . _. .... �.. . .3_,�_... d y. .. f_ ._..... Y .. _.._ ... .__ �� - s__ ------------------------------•-•---- _ . ._ ...........................•...........------....... .....................-............ ...... •-•-• . ...... Final Inspection by: ...... ---------------• _:: .......---••---•-.....-----....•.......Date ....... . SAN JOAQUIN -LOCAL HEALTH DISTRICT L3 24 7172 3-M # i E. H. 1-'b8 Rev. 5M � 4 f