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1r i FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 73—/6J Y 'Complete in Triplicate) Permit No. ..................... 9 ...:..................................................... This Permit Expires i Year From Date issued Date Issued ../,1.7a.:7_7. :w Application is hereby made to the San Joaquin Local Healih District for a permit to construct and install the work.hereir 'wk described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRriS/LOCATION ..�..�... ./.."..............�...... ....... ...CENSIJS TRACT ........................'--......Phone ..•---.......1�..... ....... Owner's Name ��.��----. u��.�.�� -•-"--- ...... .. . ' .. Address City .... r ............................./ . �........... ......... .. ...............Contractor's Ncme .5SLC - license # ...... ------ Phone .. .... S f .' Installation will serve: Residence❑-Apartment House-E] Commercial ❑Trailer Court El Number of Living units:.......... Numberofbedrooms .. .........Garbage Grinder a Lot Size ../.4 AZAG''i� a �sA1 ! Water Su I Public System and name .............."..................................... ........ ............................Private PPY Y , Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat�] y ❑ y �� I Sand Loam Clay Loam••' Hardpan - Adobe Fill Material ...U.f .. If es, a............... ......... P Q� ❑ Y type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' iy NEW INSTALLATION: (No septic tank or seep �t perrnitted if public sewer is avai:able within 200 feet,) r s}' � .:•�°'. PACKAGE TREATMENT [ ] SEPTI/C(,TANK��l� Sire•.�.1..._-x.�...............'.-... Liquid Depth .�?."...h.............. 01 r,.•� o, Capacity 1_6 x.0----. Type Material.<�VVC.RT7 No. Compartments ....... C`.. stance to-nearest: Well ...... � .'-................Foun tori- li . Prop. line... . _ r, LEACHING LINE [/j�No, of Liries .....Z.—..."........ Length of each Ilne..�:.�.�`..r_~_:.. �ota� Length f� 3 'D' Box�......_7. Type Fi.ter Material /.7......:.. .-,`.bepth Filter Material F.....f�..'.... .._�.�......._... >(.� _:� �• .�..' � Distance to nearest: Well ...:�.......i....... Foundation ...f�..�:----- :Pr`pperty Line .....,�....'_�::.... J SEEPAGE PIT [�_- Depth ........... Diameter Number ....".�0r.........7Rock Filled Yas 2,--'No C] Water Table Depth .......� ......" ---.Rock Size.............. ........... � 1 �..... Distance to nearest:WElI . ....................Foundation ......-....... .?'.. Prop. Line .................. a,;. REPAIR/ADDITION(Prev. Sanitation Permit#--------••..-------:.::.... ..... Date .................................I �V/ •,,,_, r Septic Tank (specify Requirements) ' .................................. Disposal Field (Specify Requirements) ---....... ..-r.. l.�. 3';'fir { t CCC aaJ ✓ N {ham i + (Draw existing and required addition on reverse sodel ' I hereby certify that. i have prepared this application and tF at the work will be done. In'•accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sar Joaquin Local Health District. Home owner or linen. �. -�•.;A sed agents signature certifies the foil in • i :z•." "1 certify f the perfarns nce of a rk for wiz h this permit is Issued, I shall not employ any person in such manner as to liec a bleat to W aa'tt o onsation i s of California." E Signed;. .: >�1Z-'' ...-...... !# -..� .. ....' Owner By...............:.............................................. ............-.........�L. � --'4 Title ....-.......---......................i................................. g'. ,�' (If other than owner) j f. FOR DEPARTMENT USE ONLY ;y; a APPLICATION :ACCEPTED BY...........I- ....�.. �. ............ ..'---'-'-"--........................................ DAVE .::..r.�..`r ...`. -"--- 3 BUILDING PERMIT ISSUED .........:.. " ------------------------------------------- ---...................DATE,................. . ADDITIONALCOMMENTS.... •------------- ' ...... .............. "-'--"-- '--...............---.:...;:.:..."..:.........:....._................._ a• ..... ....................... .. ..-- -'-•------. ` ... u: n .............................. &I ... " Final inspection. r.c !'Z...... - -2!l L 7 .......................... ............ .....Date.......................�......��. ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 Rev. 5M 151 i�1 W,, r� f, �}d�!'��:dvdiiG}."7'urt.G+£YISt�.,£�'.�: � '-a. .. .w,.•.�_.. _ ,,..w r., ,.... ............... .. _ ,., .... '.r yx ,, .^i,. p c