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L - r�R vrru.t vst: /7/� - -'----------- ---------- � P P ., . 1-1, - Permit No. .�!_v_D._/. ' APPLICATION FOR _ - !V- (Complete lets ncSANITATION) PVT u --------------- This Permit Expires 1 Year From Date lssued Date Issued .l�_�o• �� 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 ma/dee in compliance with County Ordinance No.;549 and existing Rules and Regulations: ` JOB ADDRESS/LOCATION ...._I7._/_`�L_, O.r._.__�_IcT0R ._ 0L1? -----------------_CENSUS TRACT Owner's Name -- . -- t_Vj_t%j..----- 5 t_v.L-r_-z__......... =- - - --------- --- ---Phone ------------ L Address -----NF.2-1-------s `--------UIC-Tn.R�--------RLQ-•--...... .. city ---D. 9kK])A ..a_-- ----------------------------- Contractor's Name - DINNEIR.------------------ ' - - - - -------------_..License # ------------------------ Phone --------------------------- ` Installation will serve: Residence Apartment House Commercial❑Trailer Court I❑ LMotel ❑ Other -------- ...... ............. ......... Number of living units:------'.__ Number of bedrooms _3_......Garbage Grinder__ Lot Size _19CR BOA--__-_ Water Supply: Public System and name .-. __....... -------------------------- .__---- __--_.--- ......... .. .... Privpte ` Character of soil to a depth of 3 feet Sand❑ Sil ❑ Clay ❑ Peat❑' Sandy Loam ❑. _ Clay, Loam �L p' � -Adobe'❑ Fill MateYial If type .G°L�1 __ZOf1 . Fldrd aii ` (Plot plan, showing size of lot, location of system in relation to wellrs, buildings, etc. must be placed on reverse side.[ NEW INSTALLATION: (No septic tank or seepa pit permitted if public sewer is available within 200,feet,) `` .r ` PACKA'GE TREATMENT [ ] SEPTIC TANK [ Size._T/� LQ X -_ .. ..._ Liquid Depth .__.Q .....--- -_- Capacity A O.0_---- Type?�Ee 1 _177Material MAKRE7F_.plo. Compartments __. ,---,---- istance to nearest: Well .._.�. _ 1 l_ ___-Foundation . .�� "f-__ Prop. Line-_s �r+- LEACHING LINE [�o. of Lines - .--- Length of each line_.. .Z _r _ ..._ Total Length h�., Q-- r - 'D' Box r:,S Type Filter Material rt�� .._Depth Filter Material _19____________________------- ►. - Distance to nearest: Well ---App----------. Foundation -._IP__fi----- Property Line _. p._ - e SEEPAGE PIT Depth ---/X_........ Diameter �,.X_g--- Number ---------- __. Rock Filled Yes ET-14-0 Water Table Depth ........ ............... .....Rock Size ._/0- -__._�ly.4V... ' Of Distance to nearest: Well _1PC�__________--------------__---Foundation AV........... Prop. Line ...... ------------- REPAIR/ADDITION(Prev. Sanitation Permit# ................ - _._---------- Date ----------------------------------I LSeptic Tank (Specify Requirements) . .--- ........ -------------------------- ----------------------------•+. Disposal Field (Specify Requirements) ---------------------------------- ----------....... ......... --__----------------------'---r•x--=--------------------- I L -------------------------------------------------------------------------------------------------------------------- - - ------ --- ----------------------------------------- - - - - -'-------------- - . --------- ----------------------------------- ------------------------•------------------------------------------------------- (Draw existing and required addition onyeverse side) L 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: "Icertify fha in the perform6 e f t work for which this permit is issued, I shall not employ any person in such manner L as to beco b[ect to Work s m n laws of California." Signed .�....t-- - ----- - ------------ ---- ------------- Owner By - - - -' - -- ----------- L -------- ------------------------ Title - - - L ------------------------__---------- (If other than owner) p FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY ------,T-`.A 0--------------------------------------- ------- -------------------------- DATE .._.. -� - 1. BUILDING PERMIT ISSUED -------------------- - ---- ---------------------------- ------------__............................._.DATE. . ... -- . --' - -' - --- ADDIjIONAL COMMENTS ... - _--- •-- -•- ------- -.................. .....--_----------- ------------------------------------ ------------------------------------------- --- ... L ---------------------- - ------ .... ------ _ ------ . -----'-'-"- ............. -' ..-.. ¢� - Final Inspe ion by: -- ....................Date .. / - �� ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT L E. H. 9 1-'68 Rev. 5M