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FOR OFFICE USE: - , APPLICATION FOR SANITATION PERMIT 76_3 �7 ........ Permit No. ............... (Complete in jriplicate) .....................................•-•--•-•••-......... � 4 This Permit Expires 1 Year From Date Issued Date issued ' ..a 3:7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application 's madgg• In compliance with County Ordinance No. 549 and existing Rules and Regulations: [I CTU F-9M5Fjf t08 ADDRESS/LOCATION .....�.:_....---_•_-_• _.,. ..CI:NSU5 TRACT ... .................»_......._.j.a i w .._..._._.......__...-.... Owner's Name � 1 ,`...••••....•• -• . .'_ --1-1 ........... _•...............� ...:"Phorie.`........ -•--•--- ......... h1�i"l i Address -------------14.62.2- W---$ra-oks:ld-e..Rd........--- ._...---....... City ...Sip.ckt ata._._......_.._.............- ........................ { 477Q24o6 Contractor's Name ....QXXFR.....__....�:.__.:. 3 :...............................................License# .... -----•-- Phone ..._............._...._•-•_••_ c Installation will serve: 4 ResidenceT!gAportment House❑ Commercial ❑Trailer Court I Motel ❑ Other ----------------------------•----•-•••--••-- Number of living units:_.._j------ Number of.bedrooms ... ______Garbage Grinder ...--------- Lot Size ............................................ _ Water Supply: Public System and na—�m ••- e --:---------•---------••------- --------------------------------------------------------------------------- -Private ® Ij Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Pept E] Sandy Loam {] Clay Loam ❑ � Hardpan ❑ Adobe J Fill Material ......__ If yes, type ............................ (Plot plan, showing size of lot, location ofsystem 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, } PACKAGE TREATMENT [ ] SEPTIC TAMC ] f;. 5ize...5_5 �__.ft, ..__ .. __. Liquid Depth ..52±.............. ..... .Q capacity _ OO ,al Type'_.c..C.......... Material...................... No. Compartments .... ................. Distance to nearest: Well C f t L........�t'--•--•-_.._.Foundation ...1-1.-.------•----- Prop. Line ....�................ LEACHING LINE [ ]� *No. of Lines, ..r� :..Length of each iine45...&S59------ Total Length __._.14.Q...f: ..4P �- ... Type Filter D' Sox j �- yp Iter Material ... ....... Filter Material ............................................� t 1bxt 21 � t 81 ft Distance to nearest: Well ------------- Foundafiion _.........--......_... Property Line ---------------.•-• -� SEEPAGE PIT [ 7 e Depth _._1.0. -•��• C a 'r _-.--2. �....._ Number ............................ Rock Filled Yes ] No ❑7 Diameter tm: Water Table Depth/A •-•A_0P-r ' --•-•-•.................Rock Size ... -••--••••• = Distance to nearest: Well ...4.4(). f-t................ ..Foundation �?�?.._ ... Prop. Line � a REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date -----•-•--------•----•----:...:_. - i Septic Tank (Specify.Requirements) •• •--- •----- ......................... -- F Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------- .-..----•-••------ I�. •-------------------------------------•-•---•-- ---------------••----••---•-----...........------•-------......----•••-•-----....__.._.............-------------------•-----_._..._. , .i �.- (Draw existing and required addition on reverse side) „r 1 hereby certify that I have prepared this application and that the work will be 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 that in the performance of the work for which this permit is issued, I shall not employ any person in such mannef as to become subject to Workman's Compensation laws of California." ~ Signed---,----- ...................................................... Owner BY �•• ---------... .Title ...! f .pf a. .r-er---------- I (if other than owner) j �y FOR DEPARTMENT. USE ONLY APPLICATION ACCEPTED BY ------ .. ........................................ DATE .. ._.............. ... ............. BUILDINGPERMIT -ISSUED .-- -----•-------------•------- ............. .......................................__..............DATE ........................... ................ ADDITIONALCOMMENTS .:................................................................_.................-•-------...-------:.............................•-------................. ! ` ..................................... .......:_.........._.... ..................__..__.... -----._.........._.--A•-____.__.... -, ! •-----------------'-----•---------_---_....___ . .... .� 7-- Final Inspection by: ....:_.. _. €r .. - Date Z SAN JOAQUIN -LOCAL HEALTH DISTRICT c u 13 241.-AR D.- rAA 7/72 3 ,4