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FOR OFFICE USE:,.' s, •,,, ��a APPLICATION'FOR SANITATION PERMIT -� (Complete in Triplicate] Permit No. ------------------- -------------------------- --------- � .� �9 ___________________ This Per _ p. -i Ex fres 1 Year From Date Issued Date Issued ____`------- .___. Application is hereby made to the San Joaquin€€Locak`!#ealrh District for .a permit to construct and install--the work herein f described. This application is made in compliance With-County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA 1 N .-!_ $ -- ----_V�/ h''�F ------IRD--`.------------------------CENSUS TRACT _;5750------- 4 Owner's Name SS ----------------- H.-A-,----�� - �-��-�-------------- - -- --------:- - ---Phone ----------- - -.-----------------•---- kAddress1 -------W------� ---- ----------- City ---- -- -1--PD 1V--------------------,'._ Contractor's Nam6<M A-_.--P/-_tnL .&JOR __.Lice nse' "#"" 3j � rPhorae • UIvDG-Rf�RovnlD � I9'TI L-t t �S _ Installation will serve: Residence, artment House Commercial Trailet Court' I❑- Imp ❑ ❑ Motel ❑Other q -fD--------------- ---- ---- Number of living units:_____ -__-__ Number of bedrooms; =— _Garbage Grinde -r . Lot Size -r e�1%6_r.---------- Water Supply: Public System and name ------------ I _-_ _ _ _________ private --------------------------------- - `Characterof.soil to adepth of 3 feet: Sand' Sil1iJ Clay ❑ - Peat❑ Sandy'Loam. Clay Loam - Hardpan ❑ Adobe ❑ Fill Material ------ __ If yes, type'---- ------------------=- (Plot plan, showing size of lot, location of system"'iii' 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,) a' i PACKAGE TREATMENT .-I-]—SEPTIC TANK-f-]z ! � `�'Size------------------------------------------------ Liquid Depth :------,----- � :. ICapacity,3f,3-------- Type ------------------- Material----------------- No. Compartments --- ------------------ Di`gtaht6,� o -------------------- 41 Di3tance°�t'err'eareWell _ ;t_______---------------------Foundation --- --------- Prop. Line ---------- ---- LEACHING LINE [ ] No, of Lines _____ ____________ Length of each line--------------------------L_ Total Length ,______---________________. - 1\ 'D' o f--------- Type Filter Material --------------------Depth Filter Material ----------------_-----------------------.... s.Distance.rto-nearest: Well ------------------f__._7F66hdc1tion ------------------------ Property Line. --------------_----- - SEEPAGE PIT [ ) 'bepth Diameter ---------`t------ Number ---------- _ ------------ Rock Filled Yes ❑ No i❑ . 'Water"Table Depth =_^ _�.= ^--�- .�-- Lack Siie r ---------- -- ---------•------- ---------------------------- -- Distance to nearest: Well --------------- ------------------- ..Foundation -------------------- Prdp. Line ---------------------- ` REPAIR/ADDITION(Prey..Sani.tation ______---___ _Permit# ____:' .. -------------------------`'Date ----=--�="--�--�-•'---cif.,-�E_ ; Septic Tank (Specify Requirements) ---------------- - ----`------------------------------=-- ------------E--------------------------------- - ----- Disposal Field (Specify Requirements) j---DI_ST7__`_ X_•--------- :_t . , -LLT,_ K Imo_'_ 5 �'AC1 ----- Pr `'-- --------------- ---------------------------1 +- : ' - --- ---------------------------------- --------------------------- {Draw exiting and required addition on reverse side) I hereby certify that I 1have 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 Son Joaquin Local)Health District. Home owner or licen- ,A ` sed agents sign i the followin �. F "I certify tha n t Worm n of the or for which this permits issued, I shall npt employ any person in such manner as to beco j r W m n's C pensbti.on taws of;Cglifarnia." !, j Signe - t. ----------------- Owrier BY ------------ - --- ------- -Title :------ - ------------ - ------------ - --------------------------------------------------------- Ilf other than owner) FOR DEPARTMENT USE ONLY APPLICAT40N-AGCEPTED-8Y-_ BUILDING PERMIT ISSUED ------------ - ---------- - --------------DATE ------------------------------------------- ADDITIONAL COMMENTS - �L� ` • j__# i -'-`- ' --_-- -- - ------- --------------------------------- _---==---- ----------------------------------A ------ - - ------------- - -- ----------------------------------------------------------------------------------------- } - -- - - - - - -- -- - - ---- ------ -- -- ------ -- --------------------------------------- - -- Final Inspee iDate ...../._-�--��--� -- _ + , -- -- - ----- ------ --- - - -- -- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M