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VC FOR OFFICE USE: APPLICATION FOR SANITATION PEyE1 MIT- ................ ............ ...... (Complete In Triplicate) Permit No. ..75-.rte _..... ..............................----........... a i 7c I This Permit Expires 1 Year From Date Issued bate Issued ............ Application is hereby made to the S1 Joaquin Local Health District for a permit to construct and install the work 'herein describe .rThiiss•:a plication is made,in compliance with County Ordinance No. 54 and existing Rules and Regulations.. <77 74 JOB ADDRESS/LOCATION :.... ...--- .......... .... ...--......._.. ' ENSUS TRACT ......__ .......... V �..2� Owner's Name ......1 - .CI .... .... - .. !_T`'6� --•:`- Qui � ................Phone _ � .ZfeR..... Address .._,......._:...f..�...... a....E.. L ' �/ _i ]3_._.. City � 1 ......................... Contractor's Name ._._A._�I...:�._.�1��P---.... •-'- '-_..:. License # s-R/�-&-ff.-R.... Phone Installation will serve: Residence N Apartment House Commercial ❑Trailer Court 0 IMotel C] Other ...................:...........'=----------- G g /� �-- Number of living it :-J_.. Number of bedrooms 3 .....Garbo e Grinders ."; .i..�Lot Size ............................ Water Supply: Public System and name ..... --------------------------- ......... ------------------------......_..--_._,........_._.:.....Private Character of soil to a depth of 3 feet: , Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ � xr Hardpan ❑ Adobe ❑ Fill Material ....... If yes,type (Plot plan, showing size of lot, location of system lin relation to wells, buildings,. etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is within 200 feet,) PACKAGE TREATMENT [ SEPTIC TANK I ] Size..S-k.11__ ...._ _..'... ..... Liquid Depth _..0... .......:..::..� Capacity lz ....... Type _FXliJ _ Material------ ----- - ----- No: Compartments ........... Distance to nearest: Well -- __.___-___-_ � { r / ___Fouridatio� •..f O-.�..._........ Prop. Line _.��__ LEACHING LINE [ ) No. of Lines - ....... Length of each line .,f,4 ,. ,:�r -,..`Tata) Length ... � �......-...... ; 'D' Box .._/.- .... Type Filter Materia / ` p ,,r' i t I/ .Xa1� _De th 'Filter Mater�61 _.._ •'....................•_-----_-- 3 i Distance to nearest: Well -- x = �lj-t1............... Foundation :,�..:...��_.....,.. ,Property Line /.;?............... --- , SEEPAGE PIT [ ) Depth .. . ... Diameter Diameter ...... .......... Number _.__: '- .. Rock Villed Yes ❑ No bI Water Table Depth --------•- -----•---------•--•------------------Rock Size) = " ----- -- Distance to nearest: Well .... •-.-._-.--Foundation _..._..... -------- Prop. Line ................ q REPAIR/ADDITION-(Prev. Sanitation Permit# ------------------------------------------ - Date -----------------•------ ......... ) I " Septic Tank (SpecifyRe�uire�men`tsl .��- ;_---------------------------------•------------------------•---- ...........:...> ............. ---••---..._... ' Disposal Field (S ecif' Requirements) . -------------- ----....------...-------..-Y ,.. " _... i e 1 ! .:..................... .... ....... ............... ..y .._...._....._ -. ............................ .. .. .- .. ..._.._....._....._._......... --........__..,............. - ...-. ..................................----------------- --------------------....-.................... ...... .. .`--------------. .............. (Draw existing and required addition on reverse side) 1 hereby certiFy,that I have prepared this application and that the work will be done in accordance with Son Joaquln�' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.;Nome owner or licen- sed agents sigricifure certifies the following: i "I certify that in the performance of the,work for which this permit is issued, I shall not employ any person in such manner as to become subject W W rkma ' Compensation laws of California." Signed -:.. . .r:.�f_... � �.-'--- --------------•-- Owner . iT , By .... , ...-- ........... ... .... ........:s-:-.....,•.....:------------ Title ................................ (if other than owner) ! �' FOR DEPARTMENT USE ONLY .... DATE ---.:.. APPLICATION ACCEPTED BY ...._:._.: .- DATE ........... . 7..._ .............. BUILDING PERMIT 155UED ..__.-._.•.........................: . ADDITIONALCOMMENTS ..,.,:.-•......... ................_. •.----------------.-------------------------...._.._.._....... - .f.,.,....... ..........,.__:---------- ----------- -------------------- .- ----------------------- - - -" ------ • ----'--... ............. -- - .............. ................... --------•-•-------- ........... --------------- ------------- - - _- r. _ ..................................•...... Final Inspection by: _.._..'.----....._ _ - .,,.,Date . ._-_ . ... >F SAN JOAQUIN LOCAL HEALTH DISTRICT I=_ w 13 24.1.•AR Rav sou 7172 3,K