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FOR OFFICE USE: - APPLICATION FClR SANITATION PERMIT --------------------- ------ 3 -------- {Complete in Triplicate) Permit No. _____--_� --------------------------------------------------------- _- This Permit Expires 1 Year From Date Issued Date Issued _�_3d_-°J3 Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION - ^-. ��Q'-,---I ----�y,� L _ ---------------------------------CENSUS TRACT _�"- ........ Owner's Name 1-FL--------- -- 1-CLQ - 1 -------------- Phone Address .-------a G_ 27-----------L5-------— L -------------------- City ------ ------------------------------------------------- Contractor's Name ----IVWdF.kZ-------------------------------------------------------------License # ---------:-------------- Phone ------- ---------------- Installation will serve: Residence F-A"partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other-'------- -------------------------------- Number of living units:-----I--- Number of bedrooms' F-- --_Garbage Grinde/rrs LotSize � ER6`�_Water Supply: Public System and name ____�___,__ ____ ,_ � �..________-_ Private - ----- Character of soil to a depth of 3 feet: Sand'❑ 5ilt❑ Clay ❑ Peat❑ Sandy Loam -e Clay Loam ❑ Hardpan Addbe ❑ Fill Material _A10- If yes, type ------- _______-______ (Plot plan, showingl°size;of lot? location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) 41l„ PACKAGE TREATMENT [ SEPTIC TANK''!? Size___. xl±t --X_Is-_ --- Liquid Depth -__Y-8/ ____________ �I Capacity 57Q__e_ Type OVReD Material-CQ66.-'v77No. Compartments -, Distance to nearest: Well _------ _�`-------__-Foundation ___ n C> f(1��,� Prop. Line --�-•--•-------- ee�� I 4 f LEACHING LINE [ No. of Lines -------:2 Length of each line----7 _______________ Total Length�___��____ ______. -" _� — `• - _De fh`"Filte� M&ei•ial + _ /i 'D' Box p .s . -,�•�Type Filter Material-- �_��- P - ----�-f-- -----------=- � --•- .s • •1 Distance to nearest: Well -__- �__ jFoundotion __f _______________ Property Line f Rock Fill" Yes No SEEPAGE PITS) tt Ot D4pth.. _ _/.- - - Diameter ___y _=_ Number ------ �- - -_ ! i❑ Water Table Depth ----s,1-. .-----------------------------Rock Size J/.,�------- ibistance to nearest: Well ____-_� �_______________________Foundation ___A----��--- Prop. Line -5 __'�'___. REPAIR./ADDITION(Prev. Sanitation-Per mit*........................ --__-_____Date ________-•---------------- ------- SepticTank(Specify Requirements) ---------------------------------------------------------------------------------- --------------------------------------------------------- Disposal Field (Specify Requirements) ------------- ---------------------------------------------------------------------•----------- s j (Draw existing and required addition on reverse side) I hereby -Sertify that I have prepared this application and that the work will be done in accordance with San Joaquin County drdinances, State:Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certi in the performance of th' : ork t ick this permit is issued, I shall not employ any person in such manner as toWecme�subject Worl 'sr nsws�of California.". Si ne9 -- - -- ------- - �- - -------- -------- Owner BY -----------------k ---------------------------------------•------------ ------------- -Title ----- ---------- ------------------------- ---- ----------------------- {If other than owner)i-I •r. ,t: FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- --- -- R--`- --- -------- ---------------------------------------------------------- DATE ------ ._ BUILD.ING_P_ERMI.T..JSS.0_ED_..... - ._................ ------------------------ --- :..DATE r , _� ADDITIONALCOMMENTS : - ----•----- ------------------------------------------------------------------ --------•-•---------------- 5 L -------- --- -------------- = = _ � Final Inspec i Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M