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FOR chi=acs.+JSE: 'PLICATION FOR SANITATION PERMIT ' Permit No. 11,f—/Q - (Complete in Triplicate) -------------------------- ------------------------------ This Permit Expires 1 Year From Date Issued Dafie 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 Reg Iations: JOB ADDRESS/LOCATION! .__,307E�f� )E7 �Q,,�/ �--------------------- ------CENSUS TRACT ----- -------------- Owner's Name ------1-�-P-V-----------<-RI FFI__t,/---------------------------------------= Phone Aq-7.'_C-77 --- Address ----- 0-70-�(------ .----- ��_�------ -- ----------- city ------------------- ��-N� ---��K DA�-�.----------------- Contractor's Name -------d9 VVf�.��.'------------------------------------- ---------------.License # -------------- ------ Phone ---------------------- Installation will serve: Residence [�artment House,❑ Commercial:❑Trailer Court El Motel ❑Other -------------------------------------------- ^' Number of living units:---- ------- Number of bedrooms _Z__.Garbage Grinder --- Lot Size ------ Water Supply: Publics stem and name -----------------------_ -------------__-___ ________________ _ Private%�---- -------------------------Pri to ❑ Character of soil to a depth of 3 feet: Sand' Silt'❑ `1"-C*:,❑ : ..PtOf ❑ Sandy Loam ❑ Clay Loam Hardpan Rr Adobe [] Fill Material ----- ------ If yes,type _...-- ------ ------------- (Plot plan, showing size of lot, location of system 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 TANK'[ ] Size---- -:----=--=-"-----------------.----- Liquid Depth --------------- .......... Q Capacity --------------------- Type -------------` = Mdt ria;---`.',--------------- No. Compartments ----------- ---•--- ` --_:__Foundation ----------------- Prcp. Line ---------------------- Distance to nearest: Well _________________ LEACHING LINE [ j No. of Lines `r---------------------- Length of each—line r-_----=------------.____-- Total Length .---------------------.----- 'D' Box ----------- Type Filter Material --------------------Depth Filter Material __--____________________.____. Distan�`e to nearest: Well ------------------------ Foundation ---_-----_-------_r� -- Property':Line ------------------.----- i SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number .--------------",-_______- Rock Filled Yes ❑ No i[] Water Table Depth ------------------------------------------------Rock Size'------------------------------- -- a Y= Distance to nearest: Well ------------------------------------_---Foundation -------------------- Prop. Line _-____________.___---_ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date ------------------------------------ ; cL ��E 1 llf� s� Septic Tank (Specify Requirements) i= --------------------- i ------------------------------------------_- nn � Disposal Field (Specify Requirements) !YISI � 1 --- -- --------------- ----------- _X1.5-�_/_tV6.7=--------- ��„"_��'". E l ----- ------------- ---------------------- ---- __ - -------------------------� ----- (Draw,existing and required addition on reverse side) `- ` —~ _ 7. 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 Regulcitions 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 airy person in such manner as to become subje to Workma Com a satio ws of California." Signed Owner By TU).Title ----------------------------------- (If other than owner) } r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- ------------- DATE _.__ - Z---Z--77 66_- ----------- BUILDING PERMIT ISSUED --------------------------- ---------------------------------------------------------- ----- - =- ----DATE -------1---- ---- ADDITIONAL COMMENTS ----- _�- _ - . _ , . _ . _ _ ___...;. ..:.. .. ..... - -- = -- --------------------------------------------- ----------- . .�_ ti ------------------ --------------- -- - --- - p Final Inspec�bn ----- ---- ---- } Date { SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ,��