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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..7_f?..-�. -------- -• (CompleM in Tdplicahl ------- 1- - ........_..---_ Date Issued This Penult Expires i Year Prom Dato issued 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{�ma/de in complies"7with Countyty^Ordiino" No- 549 and existing Rules and Regulations! 71 JOB ADDRESS/LOCF�TIOhl �Gr.F1 .a --.lid[ ^-A`"` ' �'c ----------- --_-CENSUS TRACT-• _...-------- �177x Ph Owner's Name .--- i_�t ,.---- -,Fl-rGrr._._ y`G�-�j's`f7-.------- -/,. -- �` Address ! ..�. --� ��- L�-Q/f�.... Ctly. ��RA '7 - ---- �� / -' .....License tP >�-�''.f---. Phone Contractor's Name+'4C-k� � --. --- � -`'--- Installation will serve: ' Residence❑Apartment 2240 Commercial❑frailer Court ❑ Motel❑Other ------------------------- -- — _ P_ ?.-'-------- Number of living units:_..'...._. Number of bedrooms •,�'----Garbage Grinder A�<--- Lot Site ..._��. -• Water Supply: Public System and name -----•--------------------------------------- ------------------------------------------------------ Private K_ Character of soil to a depth of 3 feet: Sand 10 Slit Clay ❑ peat❑ Sandy Loam E] Clay Loam Hardpan❑ Adobe❑ Fill Material -----------. 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�public sewer is available within 200 feet,) u PACKAGE TREATMENT [ I SEPTICTANK{� k� /� rze_.5-._'C rY L 9...---------. Liquid Depth .._ - T st: C{eY-.. Material s Plo Compartments ---- ^1'-l%112C---- YPe ...._. ^J � Pro Line ..--.._-.-_:---.-- Distance to nearest: Well ._.. .�.---------------------Foundation .f...___.. p• Length of each line---- 4r------------- Total Length -----y-�-�r-�-------- LEACHING LINE No. of Lines .._- .-_--..-- �. /f Depth filter Material ----------- 'D' Box ----1.--.- Type Filter Material - ---•-- ¢ - < < Distance to nearest: Well .7-•al------------- -- Foundation Property Line SEEPAGE PITDepth ..— ------- _..... Diameter ............... Number _.......__-------------- Rock Filled Yes ❑ No i 1 [ 1 - Water Table Depth . . ..... Rock Size Distance to nearest: Well .. -,_..Foundation ---.-------_---_ Prop. Line -_-.._-- __......._.____._____.. REPAIR/ADDITION(Prev. Sanitation Permit# ------------------• -----------------........ Date -------•-------------------) Septic Tank (Specify Requirements) ------------_----------- -•------------------- — Disposal Field (Specify Requirementsi ---'-'---------------- (Draw existing and roqu)red addition on reverseside) 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 Regulations of the San Joaquin Local Hesfth DieMd. Home owner or licen- sed agents signature certifies the following: 1 shell net employ any parson in such manner "I certify at in the performer, 0 of the work fe which this permit is issued, as to beco �ubjact to or1�t n} 's �npansaNe laws of CaiHornia-" Signed w . Sitio .. - . .��L )t_ - -----------------._.. (If other than owner) FOR DEPARTMENT USE ON Y J L J V ___ DATE .-'. -��-------- APPLICATION ACCEPTED BY------------.----------- ----- --- / DATE ----------------------------------- BUILDING PERMIT ISSUED ..-- - ---------------•------ --- ADDITIONAL COMMENTS ------------------- - - - -- -.............. - - =- ------ ------- - . _ 70 . .----------------------------------------•----- ---' - -- -....- -- --------- ------------------ ----- Final Inspection : ------------------- -------.._.._.. _ SAN JOAQUIN LOCAL HEALTH DiS I E. H. 9 1-'68 Rev. 5M �J