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rvrt vrri ,c wr: APPLICATION FOR SANITATION PERMIT L (Complete in Triplicate) Permit No --=- --- - -- This permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install Lthe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Re/gulations: JOB ADDRESS/LOCATION .j99.9 _. �AJF,-ITS_FF _.__ RD. .-._ .CENSUS TRACT ...16 .... Owner's Name L T4.ITIS _._.BRaS--- pAl RAY --_.E_ ---------., . J�MdT�) ' -------Phone .� g-.7'z�i`..____-- Address -----1 qq-`T_ ---jE...... T�F - - - -- ........ City"_B5</9-4 Q0A- -------------------------- --° ----•- --- Contractor's Name ._OA�.D.& �.__CONC-RItTE-7...�1.�'�:.0 License # LSr�.CS. /Phone ._.tf. '�7�?_. Installation will serve: Residence ❑Apartment House❑ CommgScial❑Trailer fsmi Number"of living units:___. Number of bedrooms bedrooms -.'.7, r Morel Other _-.___.__.._ _.._ _ --------- Number _ ___ V /�� ' age Gri{�der .ik9_. Lot Size _.f}CR19G.1=.._...__.._ Water Supply: Public System and name ---------------------------'_--------------------------------- -----------------Private �- Character of soil To a depth of 3 feet: Sand❑ Silt FClay ❑ PeatSandy_Loam fl Clay Loam — Hardpan 2'� Adobei'❑ 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 seeps a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size_Y.p_. __ �/ A _ Liquid Depth ---Jr-L-----,-------- � Capacity I?_.O -_ Type NEFA_B. #interipl Cp F3sLo. Compartments O Distance to nearest Well Y �v'Foundat/io�h r ll0_..___..__ Prop. Line ------------ r aS- LEACHING LINE b, No. of Lines -------j _-_..__ Length of,epch h' .._.�4/ . .. _ Total Length _._.-Ot✓--------------- fN 'D' BoxX—ES_. Type Filter MaterialrFilter Material -- ---- T...... Distance to nearest: Well ----- ------'foundation �p _ Property Line .__deo.......... 9 SEEPAGE PIT [�}/ Depth ._ 17~__�___. Diameter X.. ;Number , /- .. ._ Rock Filled Yes Er' No Water Table Depth ------------- ---------r`-------- ---------Rock Size ---------------- -------------- Distance to nearest: Well ----------- ----------Foundation --------------- ---- Prop. Line -------------..__.._. REPAIR/ADDITION(Prey. Sanitation Permit# ---------------_ ,:.__....._._.._----- Date ............... ..................) z. Septic Tank (Specify Requirements) -------- ---------- ------ =-----------------...---__---------------------------------------------•----- Disposal Field (Specify Requirements) ----_._-------,'--+------------------------- ----------------------------�--------------------._------------------- Y ,_ , - - --- a (Draw er�sting and required additionon reverse side) s 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner Las to beta u ect to orkm s Compo sation ws of California." g - --- Owner - Signed .. U--.� _.�.SJc . L By ---- --- -- -- - `- _ �! t� _ Title -------/"&-R-'------- ----- f other tha caner F K DEPARTMENT USE ONLY LAPPLICATION ACCEPTED BY -- ------------ - - ------------------ - ------------ DATE ---- IP_71-7.Z =------- BUILDING PERMIT! ISSUED ._--- - ----- -- --- ------------- ------ .----------------------------- - ---------- ------- DATE ADDITIONA- COMMENTS _. _.. .. - - - - -- 1= v✓ ;!. _. --- --- -- - � - Final Inspection�y�._ _� _._ .. _ . -- ------ - --__Date -- -- :'- I,P.--_�? ----- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT L E. H. 9 1-'68 Rev. 5M