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� �'o - v!7 t - Z FOR OFFICE USE: *--APPLICATION FOR SANITATION PER.._,-f 7 Permit No.17 ../'... (Complete in Triplicate) Date issued --- _--- – / :�11This Permit Expires 1 Year From Date issued - - �, f Application is hereby made", the an oaquin Local Health District for a permit to construct and install the work herein les and Regulations: described. This application is m -��m liance with County Ordinance No. 549 and existing Ru _ D }AAssG ? EN 14-50- C—C JO� 11A,Lt SC C11' CENSUS TRACT�SriC:F r—c Al vex ADDRESS/LOCATION .11A--- .4 ..CIN-146'S_ Q'rS � �-7AK- I s "��Vtl. 77 ��=`3�51 1 ��`Of`1 ------------------- ------------- n � � Pho Owner's Name ._�.:',r-�- .�----- Address _ � 1 LA L�t ----.-----. City - .Cl .. ` I c_ License # IC'< 1-1----- Phone,4&&. �(?�,---- Contractor's Nam . �.� -l. -----�----- �-E /�'.-- -------- Installation will serve: Residence ❑ Apartment House Q Commercial ❑Trail�efrCourt ❑ Motel ❑ Other NIG�t3.l.L-.r✓-- -T.l�f-1-�f � /7�G�'�� Garba e Grinder ------- Lot Size :._ --• -L�-!� C Number of living units: ...... Number of bedrooms _ g - I� Water Supply: Public System and name _______________----_------------------------------------------ ------"------ - - ------------------ -----Private Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat ❑ Sandy Loam K Clay Loam ❑ Hardpan Q 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.) C NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) e 4 Liquid Depth�`3 ------------- PACKAGE TREATMENT ( ] SEPTIC TANK pQ SizeQ__X- - --+-+-- -�-- q p T V6t Materia0Q7L0_ .c_-Lc---- No............ Compartments .� --------_._ Capacity �t� YPe-'' - -- ------------Foundation s -- -- . . Prop. Line Distance to nearest: Well ��C�.- - r�, ��... -- - -- Lengt oyf each line- ---��--------------•- Total Length ._�-.W Q------.....-- LEACHING LINE [ � No. of Lines �_-_-. 'D' Box .__�.--_-- Type Filter Matenalf'��1_Zf�.a-- epth Filter Material _.�_.�---- ------------- ----------------- 'D' ---�•---------- i �r �f(1 Property Lines Distance to nearest: Wel{ ✓�-�t�".. Foundation _ -____-- No Q [ 1le SEEPAGE PIT Depth ' K 7 _ � Water Table Depth _---Rock Size .- -- --"-- --------" Distance to nearest: Well _�..........................Foundation -__._.------------ Prop. Line - f Date ------------ ) REPAIR/ADDITION(Prey. Sanitation Permit# - � r✓�� _ Septic Tank (Specify Requirements) -------- '_- � ---------------------------------------------------------------------------- Disposal Field (Specify Requirements) _----- ----------------------- - - - - --- ----------------------- ---- (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: y person in such manner "I certify th • the performance of the work for which this permit is issued, I shall not employan p as to becorrle s bject to�Wor ^an's ompensati n laws of California." Owner Signed- . --- ------ ---- - By _ t�CA---------- - --�'L------------ Title --- If other t an owner FOR DEPARTWIEMT USE ONLY APPLICATION ACCEPTED BY f " y `- DATE ------. . --------- �� DATE ----------------------------------------- BUILDING PERMIT ISSUED a--------•---------------------------------------------------------------------------------- --- ADDITIONAL COMMENTS 'r ---- ---- --------------••------------•-----------------------------------------_ - ......................................... - •----- •-----... _ � --�- --- -- .. . -- --- - - - :4 I � -�- -- �/��l�---- � - -•---•-------Date ----- - ---- -- Final Inspection b ��!�-�-------�------ -----•---- -- "--' -'" - -- f SAN JOAQUIN LOCAL HEALTH DISTRICT 9 '-'68 Rev. 5M