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s FOR OFFICE USE: %� 1.01 APPLICATION FOR SANITATION PERMIT (CompioteIn..TripRcate) Permit No. C'.'3 - _.-_.---...._._.----- ---------------------- This Permit:Expires 7 Your From Date Issued Date Issued .n 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 shade in compliancesg�with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION Iht� lr 6a.._ en; .i0¢ _.-CENSUS TRACT . . - Owner's Name _ ------ Phone _ . Address -/Z --;?, G j - .-- --- ,pp�� ./ -- .-. City " ----' ---- Contractor's Name 119il`1� -:�A=l- - .-...License# .... _. ----------- Phone Installation will serve: Residence(Apartment House❑ Commercial❑Trailer Court 0 Motel ❑Other--------------------------- Number of living units:_ -----_ Number of bedrooms _._-----Garbage Grinder"( - Lot Size .1s Q .t....__............ Water Supply: Public System and name .-- .------------..... ------------------------------------------_.....Private j V Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam' 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,) PACKAGE TREATMENT [ I SEPTIC TANK I$ Size!Wdl_�--t_.,1 t. y _ Liquid Depth -T%{-._._..._.___.. Capacity'/IM-4--_ Type 'dew-*.r�ie Fial._ +t <Z... No. Compartments .i�"............. Distance to neairrest: .Well _/dam"...____......-__._.Foundation 1.4.--._....___._. Prop. Line . .�.i........._. LEACHING LINE [ ] No. of Lines _s7._-------.------- Length of each line-----1Qb-------------- Total Length .3O."d.............. ... �} 'D' Box VC4*.k*4_ pe Filter Material ,.?...........Depth Filter Material _-/-_f.....--------.--------- Ot Distance to nearest: Well ... -------------------- Foundation __..... Property Line __. .................... SEEPAGE PIT [ ] Depth __--- ----------- Diameter ._..._..-._.... Number ---------------------------- Rock Filled Yes ❑ No JO Water Table Depth -.-..----..... ....... ----------.-----.......Rock Size -------- -- N Distance to nearest: Well ------------------- ....................Foundation ____...._._.. Prop. Line ............... REPAIR/ADDITION(Prev. Sanitation Permit# ...___ ------------ Date .............. I Septic Tank (Specify Requirements) --------------------------------------------------------'------------------------------- --------.--------____,.._--- Disposal Field (Specify Requirements) -------....._ - ------------- - - ------ - ----- '- -- - - - ---- --- .... -- - - - --- ------ - - _.. (Draw exist-ng- -an- -d- --- — required-- -additi-on- --on--reverse side)------`----------- I herebycern that 1 have r certify 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 Son Joaquin Local Health District. Home owner or Ilcen- sed agents signature certifies the followings "I certify that in the performance or the work for which this permit is issued, I shall not employ any person in such manner as to b e ubiect t arkman's Compe lays of California." Signed -- . - --_ --� .. - _ ----- Owner r� y By C Q�z.-4arr f� --- ----------. Title ; - - - ----- X, FOR. DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- - --- ----- -------------------- ------------------ DATE _�.Y: '_e'�-D__'._._.J9.ryrs.-.--..�.0 s��jF_tin-a�� :��l�.FRe�9s,_ �.t�+Xr�i-s+..z.n.�•k•oyC..es ' NG PERMIT ISSUED... ...... Df7E ADDITIONAL COMMENTS ------ --------------------------------- .. __ . ---- .-.-- ' --- - - - - -- -- . ----------- Final - ... . . . -- Final Inspection by: - _Dat SAN JOAQUIN LOCAL HEALTH DISTRICT r. E. H, 9 1-'68 Rev, 5M