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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i - Permit No. :72 ....5.. _.._............................._..._....__...__..--- (complete in Triplicate) - ----••.....................:............:. ..,�'�. Date Issued ....................:.................................... This permit Expires 1 Year From Dow lsstted istr and l the Ormit to con Application is hereby made to the San Joaquin Local with Count' rict Na. 549 and exist g Rules tand Reguipt onsrein I described. This application is made in,compliance w Y i., 33.....%r:ac- ...............CENSUS TRACT JOB ADDRESS/LOCATION �-�..�6.0....5....�iN.-.�/-....------ - .,......................... .......Phone Owner's Name .. ar- ...C3'.?`tt: .0 ..'''J-..................................... .. 3 s y.` ..7.., ..._.. 3 Y^r Address ; ;�.::�o...SL.o.Q....T S.../ .. .3_ �' �. ... _ . ...---......City. ... .7 - �/_. Y;........... Contractor's Name ... ................:.......................license ... Installation will serve: Residence 2_4`artment Housefl Commercial❑Troller Court ❑ Motel ❑Other ........... .. ....... .............. I..... � �.:y V! ] • - ................ •..._ " �{ Garbage GrinderLot Number of living units•...-� Number'of bedrooms ._-- _••-•-- ••�-•.••"•• � Private Water Supply:-Public-System-and name ............ w Character of soil to a depth of 3 feet. Sand❑ Silt❑ Clay .gar/.Peat❑ Sandy loam ❑ Clay loam 13 i Hardpan Q Adolf 1 F#H-Material ...._if yes,type ............... ..........:. "(Plot plan, showing size of 'lot, location of system in relation to wells, buildings, etc. must be placed on reverse ilde.l NEW INSTALLATION: (Ido septic tank.or seepage pit .permitted if public's sewer is ova liable within 200 feet,) s -- Liquid Depth ` . PACKAGE TREATMENT I ] SEPTIC TANK I I Size................... - „ Ftis � Capacrry .................... Type ............. Material......... No. Compartments ns Distance .to nearest: Well .................••--••-,-....... ...Foundation . ... ....... Prop. Line ...................... Length of each line.=:--- ...... T Length 4 LEACHING LINE [ 1 No. of Lines ................... g 'D= Box ,NType,Filler Material Depth ;Filter Material ............................................ LA = Distance to'nearest:Ave, .............. Foundation ..................... Property Line r______ ”; Rock Filled Yes ❑ 0 SEEPAGE PIT ( 1 Depth ;•- Diameter r Number. 0 Rock Size .................... Water Table Depth ••----._.....-. -----•.... pF It t Line ...... ........... Distance to nearest: Well ' Foundation ._... Prop. Li k e - REPAIR/ADDITION{Prey. Sanitation Permit#.-_.-....._......_._: - Date --.. ------...... } Septic Tank (Specify Requirements]°=--.... ... -= ..... '...... ...........................................,:.. t Disposal Field (Specify;Requirements �-d ,Odd � ................................. .. ----- -----------•--------------- -- ----------••• ---••--.._.. ----- ..................... ........... ................__.._..........-- F. i ...... --------- --• ••----------- ------ -------•------------------------•-•-•-------- .....................•- ------••----•--.......----------... :. Lil (Draw existing and required addition on reverse side} _ . �. �-...�.--'=-_= �•'---_-=ter:. T I .hereby certify that 1 have prepared this application and that the work will he done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Dlstrict. Home owner or Ilcett- sed agents signature certifies the following: �` ""I certify that in the performance of the work for which This permit is issued, 1 shall not aneploy any parson in such manna! as to become subject to Workman's Compensation laws of California." r� Signed -- - - - -- --------------------- Owner:' ----------------------------- BY ---- 7tii- FOR other than owner) D PARTME LISE ONLY APPLICATION ACCEPTED BY --- ------ ---------------- ------ - ------- ------- -- �-` �� ---: - - --------.,DATE .:ra2. :�3-7�.---- �---------•--._ .. - ----------.DATE ........................................... BUILDING PERMIT ISSUED ----------_ --------- ----------- --- ------•• -•••._.. ADDITIONAL COMMENTS :................................. ............................... ....... ------------- v- ... ...._. Final Inspection b �-._- Date ----- ...-- - EH 13 2!t x.-68 5M SAN JOAQUIN LOCAL HEALTH i!:DISTRICT 8I74 3M i