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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 70 Permit No. ....2.3:".._ (Complete in Triplicate) .......... --------------------------- -- ------------------ _ _ _ __ This Permit _ ___.__. .. _.- ..___.. .. ExpirPs•1 Year From Date Issued Date Issued r_ Application is hereby made to the San Joaquin Local 1-lealth District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION_-F._7-------- _.._ _- ,:.F-O NTB. E- - -------------CENSUS TRACT .--- .. _... 6// 3/9 O Owner's Name ��}of �/� :!.�!.- — I------------------Phone _ Address 34-3-Y-3--------jlr-7—----- LNTR. city --------Ql?K .................................... Contractor's Name ----- ----------- --- --'-'----....License # ;--------------------- Phone ------------------------------ Installation will serve: Residence RKPIO;ment House C] Commercial ❑Tiailer Court ❑ Motel ❑Other------------------------------------------ Number of living units:-_._ _._ Number of bedrooms : -._-Garbage GrinderLot Size _. Ct3rt}� ............ Water Supply: Public System and name ._ - ' Character of soil to depth of 3 p feet: Sand'❑ Si i� Clay E] Peat El Spdy Loam C] Clay Loam�- Harjlpan Acae❑ Fill Material //Ot�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 seep a pit permitted if public sewer is available within 200 feet,) ''JJ PACKAGE TREATMENT [ ] SEPTIC TANK nn Size_ x./Q_=X �,-. _---- Liquid Depth --y_I ---------- J Capacity _L2�_O-._ Type PBEX4 7 Material-wfvCR_T7 No. Compartments ___�L-+ W Distance to nearreesst; Well .._. _..'~.- -_... Foundation .-JQ__-f_ Prop. Line ._,1r-- s LEACHING LINE No. of Lines _._�___._.____. Length of each', line.._._? _-----_-__ Total Length ---fs� 0 -------------- D' BoxyF�_ Type Filter Materi9l . _ C ..Depth Filter Material -.__....�� Distance to nearest: Well ----NW�__ ... Foundation _.__� _." .- Property Line _�__ ...... SEEPAGE PIT [� Depth --- _ Diamete41-X0-_ Number � __.. ._ Rock Fi ed Yes Ey' ❑ p U � r Water Table Depth_ /-Q Rock Size .__l✓Zy__-(_� y, Distance to nearest: Well -----/a __-- _>Forclation ..../ ----------- Prop. Line __. ---- 4- REPAIR/ADDITION REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- ------,Date ,___...._._... Septic Tank (Specify Requirements) ---- ----------- --------- --------------------------------------------- -------------'----- ............... C i DisposalField (Specify Requirements) .......................................................... -------------------j------------------------------------------------------ ------' ------------------------ ----------......... (Draw existing and required addition on reverse 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: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become sub�f to orkm Compensation laws of California." = Signed ----[✓�'_. A ------- -----------_--------------- Owner By --------------------------------------------------------- ---------------------------------- -------- Title . ------ ---- ------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------T ta!________________ 7 -- -- - --.---- ---- -- --- --- - -- ---- -. DATE ----... --.. ._ BUILDING PERMIT ISSUED ------------- --- --------------- — — -- --------------- --------DATE --------------- ADDITIONAL COMMENTS .----- - -------; - ------------------------------ ---------- ._.. .. . . T -- -- __ .... n Final Inspe // /��/'' --- .........Date .... - � .. - SAN JOAQUIN LOCAL HEALTH DISTRICT L E. H. 9 1-'68 Rev. 5M