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YVK VrNU Jbt: APPLICATION FOR SANITATION PERMIT IV7 ' I � � (Complete in Triplicate) Permit No. _. --- .._.._--------_ -----------------------------------.. This Permit Expires I Year From Date Issued __ Date Issued -------------------- Application -------_----___-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 m/a/dee in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ JOB ADDRESS/LOCATIONP...--_IV.I_CTrod]f..--13.Qr..------- ------------CENSUS TRACT Owner's Name ----------- �Vl-(1�- - H-u-ta-Z.-------------- -- --- ----- --- ---- -- -Phone Address - ------ ---- --lutc-rag ---------RD- ........ City --- - ---------------------- . ... Contractor's Name -----0WN.EP�----------- - - --------- License # ----------------------- Phone --- ----------------- Installation will serve: Residence [Apartment House❑ Commercial❑Trailer Court C] _ Motel ❑ Other -------------------------------- ----------- Number of living units:-__t..-- Number of bedrooms ._____Garbage Grinder ._ Lot Size .07!�1zE-E}-fG�.-_____ Water Supply: Public System and name -------------------------------------------------------- --_-__ ..._. . . _ . Private Character of soil to a depth of 3 feet: Sand ❑ Clay F] Peat❑ Sandy Loam ❑ Clay Loam Jididpan Adobe'❑ Fill MaterialXI$=1f YK type .(!Uf1 _ __40119" . (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 seepa pit permitted if public sewer is available within 200 feet,) �r PACKAGE TREATMENT [ I SEPTIC TANK rj Size _.LO-X-_� ._ // [ _-- Liquid Depft Q -_ CapacityJ�Q.0_:.. Type - FI I.57—Material4l /__ TFC- Compartments _'Z,,- Distance to nearest: Well -----50. __ 'f-____-----_Foundation ----A? 't-_ Prop.Line LEACHING LINE [Ij"/No. of Lines -----:2�=...-.-. Length of each line------7,5--(---_----- Total Length _-__n/5_ t - 'D' Boxr_r__5 Type Filter Material 4CK_-.-Depth Filter Material �9_._---- -..---------------- Dista nce . - _Distance to nearest: Well ---A999 Foundation ------- Property Line _-_ 3 r -- [ Depth _ -...__..- Diameter X. _.. Number -._ 02- ---. Rock Filled �Yes 4�o SEEPAGE PIT ❑ Water Table Depth __4Q..r ---------------- 0-- Size .- _.2i-� r Distance to nearest: Well _f ...__.-_--------------_--..Foundation Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------ Date ---_-.-__..._...-_.--------..1 Septic Tank (Specify Requirements) ------------------------------------------...----------------------------------------------------_„'---=----------- \ --- Disposal Field (Specify Requirements) ----------- --------------------------------------------------------------------------------a-..:------- ----- - - --- - ---------------=-------------- ------------------- ------------------------ - (Draw existing and required addition oh, feverse 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 Regulations of the. San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify the in the perforVas work for which this permit is issued, I shall not employ any person in such manner as to beco blect to Won laws of California." Signed - - - ------- !t!tp ----------------- Owner By------------------------------ - ------------- ---------------------- - J [ 1 Title --- ---------------------------------- -- ---------------------- (if other than owner) pp FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY - rA_19-------------------- -------------_----- ----------- ------------ DATE lk-Z -749....-- BUILDINGPERMIT ISSUED ------- --- ------------------ ----------------------------------- -------------------------------------DATE ADDITIONAL COMMENTS - - - - - ---------_---------------------------------------- - -, - .... .. . . . .. ... . . ... . - _-- - - --- { -- - - . . Final Inspection by: .- -- ------------Date ��- �Q - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M