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v FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,rhe 3-1----I-�_ -�- r7105r / -- - �- -•-.�..- Permit No. -� ----- (Complete in Triplicate} dIV` Date Issued _ ..31.. 51 f ------- This Permit Expires 1 Year From Date Issued _A/ 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 made in compliance withCounty Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATION/__ _ P__►- -",- C -- ----------CENSUS TRACT -------------------------- Owner's NameClff7- Na -,fi ° ?�/� f' z� Phone .416 6- Address 2&ham- , s�C� v�'------------------------------ - City9 l/' Contractor's Name-77212) _ .__5f-. � __',&ro-'�� icense # - � - �"Phone Installation will serve: Residence XApartment House ❑ Commercial :❑Trailer Court ;❑ Motel ❑ Other -----------------------------------•-------- Number of living units:-----I----- Number of bedrooms _-�--_-GarbageZ(c der ---- ----- Size>--3._ --------------- I Water Supply: Public System and name _ 4 4 - ------------------------------------------------Private ❑ 1 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat ❑ Sandy Loam ❑ Clay Loam D f Hardpan ❑ Adobe Fill Material ____________ If yes, type ---------------------------- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) ' I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK Q Size_ f V.__�.3_ ______________ Liquid Depth _-_4 -_------.---_- I 1 Capacity -.?C2�?___--_- Typehr�.c_&-0k--_ Material.r7war L----- No. Compartments _--�:--_---_-- lDistance to-nearest: Well _'h`_l_c-K-k–—------------------Foundation _1_0_-_-------.--- Prop. Line ----------C6--__---_ LEACHING LINE Ke No. of Lines -----. -------------- Length of each line----94?-'o------------ Total Length ----- --_`--------_--- ' D' Box ------------ Type Filter MaterialDepth Filter Material _ -tle _ --------- A# ________ _______ ._____._____*1 Distance to nearest: Well - aA�--__-.--_ Foundation --cZ-.D--- Property Line ' SEEPAGE PIT Depth ----- Diameter .3.3q--- Number ____I__ ____ ___________ Rock Filled Yes X No 0 r ;}Water Table Depth ---------6-,Q--- -----------------------Rock Size ------------ / ' ! t Distance to nearest: Well ---r"t o1�t_ .--------__-_.....Foundation __._ S.�__ Prop. Line ---___-__"_�....-.... REPAIR/ADDITION(Prev. Sanitation Permit # -------------------------------------------- Date --------- -------------------- : ------------------------------------------- or ` Septic Tarik (Specifyi'Requirements) -:--- ---------------------�----------:------------- --.._---------------------=---•- Disposal Field (Specify Requirements) ------------------------------------q----------------. -` = ------- --------------------- -----b-- ------------------------------------------------ ------- --f---------------------------------- ------------------------ =-------------- ---------------------------- J. _,m (" (Draw existing and regdired 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'nof employ any person in such manner as to beco ct to W kma C pe71 f lifornia." / a Signe ------ 7 - BY ------------- --------------------------------------- ------------ --- ------ Atle ---- ------ --------------- ----------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ------------- ----------------------- -------------------------------------------------------- DATE ----------------- BUILDING PERMIT ISSUED -. ---------------------- --------------------------D--A----T-- -----DATE --------------------------------------- ADDITIONAL COMMENTS 'l_ d�-- ica ._ - ----- ------ - ---------- ------------------------------------ l _� � �1 5- ?;; -__-�-�- :.__� --------- - - --------- - ---- Final Inspection by: r� -Date . _ f .- SAN JOAQUIN LOCAL HEALTH DISTRICT iE. H. 9 1-'68 Rev. 5M ®(.