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jr 5_F-']:OFFICE USE: APPLICATION FOR SANITATION PERMIT --- )Complete in Triplicate) Permit No: ---- - ----------------------- -------------------- ------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued --- 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 with County Ordinance No. 549 and existing Rules and Regulations: ;1,, -_. _ — 1.7 JOB ADDRESS/LOCATION� .--31o�_7 ----- ��-------- / A-LL---- R-D_-- -------------------------CENSUS TRACT J� ---------- , Owner's Name ---------(7--Edd` �_64-f A-----------PU T1�rO-A-6)------------------------•------------------- Phone ---------------------------......... Address ------------303- --�f ------ -- ------- :LL - _ ==' `='-==-T-City _ J�S /� Contractor's Name --- --- UUAJ F—. License# t ` Phone = i �.Insta`llation will serve: Residence ❑Apbrtment House❑ Commercial :❑Trailer$ r Number' f•.Iivin units:-_._ _______ Number of bedrooms ---/----,.Garbage_ Grinder] , Motel ❑Ot er __-___-'----•_---- g `,��_.. Lot 5ize ---�_--�_��A-�,�_.---......_ ' Water Supply: Public.System and.name --__---_---------_ - •- _-- , :, ---------------Private Ems' Character of soil to a deptR of feet: _Spnd❑t S 1t❑rClay�� Peat Sandy Loam [+e day,Loam :❑ 5 .Hardpan E]- Adobe E]--o Fill Material ___ :F If yes, type ___------------------------- (Plot _ ____________________(Plot plan, showing size of lot, location of 4stem in relation to .ells, buildings, ietc. must be placed on reverse side.) {� NEW INSTALLATION; (No septic tank or seepag rt permitted if public sewer]is"'available within 204 feet, PACKAGE TREATMENT € SEPTIC TANK Size;_- ':_ : .��_ Liquid De -------- ------.----- W CapacitylVlaterial /vC _ No. Compartments --- ---- V -- ---- istance to newest:+Well• __=____r, ___________Foundation ___1D__'f:__ Pro Line ... r I _,�_ LEACHING LINE No, of.Lines -------J-------------- Length of each line-------7a------------- Total Length ,._ __._7[9........... l -Box�e.5_ Type Filter Material Depth Filter Material ------1__7_ __-........................ istance to nearest: Well ____,5D------------ Foundation ---lQ-------------- Property Line --_______________ SEEPAGE PIT Depth ----------- Diameter "Number -----/................... Rock Filled Yes P"No 0 a FI -TER 13 A 'r '� Water Table Depth -----3a?---------------------------------Rock Size. X-- - r Distance to nearest: Well -------75---- ----:___-_____ _Foundation _ _/ ___� Pro ? /i.� -- -- - --- P. Line .. ..--•----•------ REPAIR/ADDITION(Prev. Sanitation Permit# ___________________________________________ Date _____}_t.__._____________________) : Septic Tank (Specify Requirements) -------- ----------------------------------------------- -`---------- - ----•- ' F - Disposal Field '(Specify Requirements) -------------------------------------------------------------------------- y i l (Draw existing and required addition on reverse side) I hereby certify that 1`Ftave 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 t t in the performance F t work..for which`this permit is issued, 1 shilll not employ any person in such manner as to beco subject to Woikm amp i ion laws oE. California." { 7 - ! S• � r igned _.. -- ----- -- --- . ------ —' ---------------Owner----. l ---'--= �� —•= ..- ------------ ------- ------------------=------- By -------------------------- ----- -------------------------- '` _ Tit e (If other than ;owner) 4. FOR DEPARTMENT USE ONLY APPLICATION IOCEY -- ` _ Y T f TE ---- ' BUDNGPERMTSSUEED - - DATE ----- ------------ ------------------------ -----------_ -- = ------ t e.: ---------•-- ---- -- -- ------------------- -------------- ------------ -------- ------=----- *' -------- -- ------- - _ .� _ ..�..�._ _ __ _ .._ r._..�.r �_ ------------------------- ------ ----------------------- Final --- - - - Final Inspection - --- "�- +r ------------------ Date _ . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M