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FOR OFFICE USE: If, w PLICATION FOR SANITATION !� iT (Complete in Triplicate) Permit No. .., `3 ----------- . ----------------- -------------- _g/f / ?his Permit Expires 1 Year From Date Issued Date issued Application is hereby made the a Joaquin Local Health District for a permit to construct and install the work herein described. This application is m co fiance with County Ordinance No. 549 and existing �Rules and Regulations: 14. 11ALLE: JOADDRESS/LOCAOTION -.9I----_ _-- �QN_1 48_` TS---f d._- r� _.I S ` GseA11CL b NSU/S TRACTT�3r}CiC''�i I � Owner's Name _4.T__y-.------ . .......... ...... ..................... ---------Phone4--77-r3S.-1------- Address ---------(.a_(P V-`A__E5A DbA/------ __-9..��.-----------. Cit _,5_7�.'j_C�fCrV-A/- �{ `--------------_------ P v _ Contractor's Nam .. / -. ' x-----�-------Sai'UL -------.License # 100 Phone4&E?N?.07_.-- Installation will serve: Residence ❑Apartment House❑ Commercial :❑Trailer Court Motel ❑Other _M06.1_LE___7RA1_L &_Q Number of living units:... Number of bedrooms _�___-Garbage Grinder .------ Lot Size __. ___ _ _ _ ___.__-__.- Water Supply: Public System and name ---------- -----------•-------------"----------------------------:---•-•--------------------------------------.Private Character of soil to a depth of 3 feet: Sand'(] Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ___.____-:.__________ Ilk (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,) V PACKAGE TREATMENT �� ----- Liquid Depth 15 ---- --- - [ ] SEPTIC TANK!D4 SizeQ__K.�.�_,..r__________________ q p Capacity/900----___-__ Typ _ Materia04LdAt <_. No. Compartments ......... r `, t Distance to nearest: Well .00F1___ __ ____________Foundation _rf�(�.__._.__._-- Prop. Line _ _- ..._____.___ LEACHING LINE [ ] No. of Lines C �----------____ Lengt of each line------ .10............... Total. Length _-I-_t9.-1 �._..______. .1- - 1 Q@ � �� 'D' Box ---/------ Type Filter Material��'�9__-_Depth Filter Material --1 �---------------------------- ----- 0 i Distance to near t: Well .,S.l�Q___:__..:__. Foundation 140. Pro er Line p +� .5---------------- SEEPAGE PIT [ ] Depth _ No i 3 Water Table Depth y --------- Rock Size - -- ---- ---- ---- ------- Distance to nearest: Well -� ___----Foundation -------------------- Prop. Line .................. . REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ - Date ------------- ) Septic Tank (Specify Requirements) ...... --- -- - - �C.��.: Disposal Field ISpecify Requirements) ------------ ------ ------------------ ---------- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will lye done in accordance with Son 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 th tlrL6 performance of-the work fo hich this permit is issued, I shall not employ any person in such manner as to levo e s bject tosWor an's mpenaat' n-taws of California.'= Signe -------- -- - ---- --•-------- Owner By _- ---- ---- --- ----- -- - - ------ - -------- ------- 'i---------- Title ........ 4----------------- -------- ------------- 0 other t an owner ;FOR DEPARTMT USE ONLY APPLICATION I� ACCEPTED �Y ':.. - DATE ------------ ---------- BUILDING ERMTlSSUD - - -----------------•---------------•-•------------------------------------------------------DATE .------- ------- ADDITIONAL COMMENTS -------- ---- " --- ---------------- ------------------------------------- = ------- ------ -------------------- - ---------- ---------------- ------------------- ------------------------------ Final -- ---------------------- - -- N J � f� ?A ---- Final Inspection by: _ :y, j yj ------ --- - Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 sT-'68 Rev. 5M f•, 4 3r