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r FOR OFFICE USE: _ � a APPLICATION FOR SANITATION PERMIT -, --- ----------- - --------- ----•------ ----------- � Permit No: -- -------------------------- (� a-gSa� ( mplete i Triplicat This Permit Expires 1 Year From Date Issued pate Issued --4- ------------ Application �_� -- Application is hereby made to the an Joaquin Local Health District for a permit to construct and install the work herein described. This application is mad ,in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ON . ^ - CENSUS TRACTS Owner's Name -----VJ�_R1�O-A-------- / l-n-U-pj ---- ----------------------------------- I-------------------Phone Address -----16-SQ-S-- _5-------- SC_AL.ON----8 City ---MA.ts ri-rC/�}--`-------------------------------------- Contractor's Name -------------------------------------------------.License # F?. _ Phone installation will serve: Residence ❑ Apartment House❑ Commercial Residence -El ;[ -Motel ❑Other ------------------------------ Number of living units:.----/ -_- Number`of bedrooms --- ___-___Garbage Grinder WO Lot Size l TZ,E-4-6 .............. Water Supply: Public System anXnam k-v__ ,.';1___ ----.Private---------- -------------- ------------------------------------- Character of soil to a depth of 3 feet: tSand'❑ Sil ❑ Clay E] Peat E] Sandy loam C] Clay Loam. Hardpan Adobe-❑ Fill Material ------------- If yes, type ---------------------------- (Plot -------------------------_(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc...-must] be placed on reverse side.) �J3 e e + NEW INSTALLATION: r {No septic tank or seeps pit permitted if t�blic sewer_is avmldble within 200 'Feet,) �� L/' PACKAGE TREATMENT { ] SEPTIC TANK[ Size_- _' jQ__x5_.--�,:._�__-___ Liquid Depth ------- f__ __,____. t� . Capacity/ ©On �T�p pPA1CF19b_ Material- A1TCAT�1VoCompartments ___��-� ........ 0 istance to arest: Well __ ____"'�'-------------Foundation -----±-___ Prop. Line LEACHING LINE No. of Lines ---- ------------ Length of each line----7,5.`Y-------- Total Length :___�757.-fl.-.. D' Box ? ':Type Filter MaterialpC __-DepthFilter Material ___J_7__'0 / _ y ____________________ ________ Distance to nearest: Well ___ l��___' �� F'74 �_________ Foundation �I�___` - Property Line _____ . ._:_....... SEEPAGE PIT Depth ---------- Diameter X_tl Number --.-. -11 ____.____._ ____ Rock Filled Yes �o i❑ Water Table Depth ----------------------------Rock Size - Distance to nearest: Well -- 414.0.__.......l)l------------F ou ndation ---/0---- ---- Prop. Line -............... REPAIR/ADDITION(Prey-Sanitation PO` mita# ---.-r ------------------------------------ Date ----�--------------------------} f Y y . �l A Septic Tank (Specify Requirements). ° f U�P►I'7-` ) � ------- -------------------------- i ------- Disposal Field (Specify Re uiremes)ntr=- -- --------------------------------G------- -------------------- :- ---- ' ----------- -------------------------- - = ,=------------------ ---------- ------------- - --- --- ------------------------------------ -----------------------------------I------------------------------------ 1 -------------------------------- Orcilk�e cisting and required addition on reverse side) ice" I hereby certify that I have prepared this application and that the work will be done--in-accordance with San Joaquin County-Ordinarues, State Laws, and Rules and Regulations of'thekSAn Joaquin Local ,Health District. Home owner or I14n- sed agents signature certifies the following: I "I certify 1n1 the erform nce of the ork for which this permit is issued, I shoil--not emloy any, p#arson in such manner as to bet sub' t or ma 's o ensation laws of California." up ' f Signed t --------- ------------------------------------- Owner A j Title -- T_. Y ------ ----------------------------------------------------- ------ T (If�other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --j � - ` ------------------------------------------------------------------------------- DATE ----0-pr._!!972--7 ' E' BUILDING_PERMfTJSSUI:D- 1_ "'---- ADDITIONAL COMMENTS --- ----- ------------------- ------- o �i ° , ------------------------------------ -------- ---------------------- -- -----agow - -- ------------ ------------ ----- ---- --- ----- ------ ---- ---- ---- spectr - - -----Finalln -- ----- pate - -- --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M ; I