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,FOR OFFICE USE: .� APPLICATION FOR SANITATION PERMIT .....................................:............I.... lCatnplete in Triplicato) Permit No.-. 1 .. ..........._............................................. Date Issued .2 ......................................................... . This Permit Expires t Year from onto Issuod . .......... 2-2cj--0&f)— 9 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 is m de in compliance with County Ordinance o. 5.49 and existing Rules and Regulations: JOB At�DRI:SS LOCATION. �'.. .,1 ....... NSUS TRACT .....:........ Owner's Name ... t��._.. ..CZ' r�r�f_J/----- -- � f�C.l.... �dJ�jc_26! /.G�•Phonae `�� r f . Address -1.2j� ,.lr.. t�l� .( p3es.� ..City .-- ..................... ... Contractor's Name f�� .............................. ................•--......License# ......... ............ Phone ....................... _. Installation will serve: Residence 0 Apartment Hou Commercial caller Court 0 Motel ❑Other • � I Number of living units:............ Number of bedrooms _...........Garbage Grind ........... Lot Size Water Supply: Public System and name ______________________ ......Private ❑. Character of soil to a depth of 3 feet: Sand❑ Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan Adobe ❑ Fill Material ............ if yes,type............... ............ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.J .� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT 1 SEPTIC TAMC{ Size....�� ........................... Liquid Depth -------------------------- Capacity _-_-..----.-:___- ---_+ I Ca aci { ._ Material No. Compartments � Distance to nearest: Well ' _._ ___f'..............Foundation Ar........._ Prop. Line ... ' A LEACHING LINE (� No. of Lines .. :................. Length of each line... , .... Total Length .... r_-............ 0 ' ff Depth Filter Material .�.r�._ D' Bax ...F.:..... Type Filter Material ...ac� p ._ _.....--•-;.._...(..............4 . Distance to nearest: Well ...�do%----It_. Foundation___. L1'- ..__:.... Property Line -.�?r�f.............4e > .- . ( � Depthr r _,�_ Number �- ........ Rack Filled YesX Na >C k" • Dlornete ... 3 Water Table Depth ! _ -C "` )_,._Rock'Size ..........................:..... ........_:Foundation i. �., Distanoa to: Barest: ell --- 4 -- - Date foundation 40.. � Prop. Line �....7�...... REPAIR/ADDITION(Prev. Sanitation Permit# ..................__.........._ Septic Tank (Specify Requirements) ...........-•---------••--•..................••---•---------......_._.....----.....•....---•-•------ i Disposal Field (Specify Requirements) =T - -•..............•----------------------.._.....�...........................: ..:.: (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 a f the San Joaquin Local Health;District. Hayne owner or ikon- sed agents signature certifies the following: "I certify that in the erformance he wo for which this permit is issued, I shall not employ any person In such manner as to become ubj to rk 's amp ati laws of California." Signed ---- Owner -----------------•--•----•-----••----••---- -- Title ....._...-----...---•--.... -------------- ------------ --------------- (if other than owner) k FO EPARTMENT NLY -' APPLICATION ACCEPTED BY DATE ..7.. 7 .. .. = BUILDING PERMIT ISSUED."" o *_.. . ---DATE _-... .... ..........._. ADDI f0 L COMMENTS : ?Z -;Se~'�p1 •.... ._ - ,. 1 . ...... �f --------- - r �-��-CCy��L'r��-A--�-C7/ar_-- �io�-�f,e�f��fs�jfc�f��.�'-•-.. ................•----•-------...................- .............. ------- - ----• -- ---------- ...__.._........__._. ....._..__sir.... ............................ ................................ ..... -------------------" Final Inspection by: --_. - " ... `" Date . .. . ... .. ................ EH 13 2t, 1-68 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M 4