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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate} Permit No. 7 5L............ / U This Permit Expires 1 Year From Date issued Date 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 Regulations: JOB ADDRESS/LOCATION --- ------- r ..........................CENSUS TRACT ................... .- -�... ........................ •-----....------•Owner's Name ... :_:..., ........Phone y Address ........ ........ ----._.._.__.. -----• Y �4. _fit. ��t ..- -- Contractor's Name, �1J../�t?.._ --.' f�.ec .,G ----------------License # -.-- .-._.....- Phone Installation will serve: Residence partment House❑ Commercial []Trailer Court 0 - ' Motel ❑Other ........... ---------------------- Number ---- -•--Number of living units,. Number Number of bedrooms _ _.__.Garbage Grinder ............ Lot Size ...... Water Supply: Public System and name ---...__ Private ❑ Character of soil.to a depth-of 3--feet:-i,..r5and n Silt❑'�. Clay ❑'- 'Peat❑- Sandy Loam'❑ Clay i.oam❑� Hardpan ❑ Adobe [ ril Material _._._. ... If yes, type ............................ (Plot pian, showing size of lot,--location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tankior seepage pit permitted if public sewer wer is available within 200 feet,) r�- i PACKAGE TREATMENT SEPTIC TANK jyY Size._.5._ .K_ ..k.. ld.. q p ......--.... Liquid Depth -_- ............ Capacity ..lZd0-- . Type -t _ `Material_ aAl `PtCNo. Compartments __.. Distance to nearest: Well . .................•-_-_--._...._....Foundation ....10.........--- Prop. Line _.,25-0.......... LEACHING LINE No. of Lines /...---- ..... Length of each line ._.._ Total Length .. ........... - 'D' Box J. -. v`> Type Filter Material ....Depth Filter Material -1 q.................................... 4 � Distance to nearest: Well .._..__.._..._...__�,� Foundti _ . aon ..... .._. _ ��- ----- ... Property Line ..-•---....----•._._...- SEEPAGE PIT- [ Depth �J ".._•._... Diameter _ -.... Number --- Rock Rock Filled Yesj& No 0 Water Table Depth ... 3- ----'--Rock Size --•-• ---------------------•--• S .rx f Distance to nearest: Well ................`.----..------------t-.Foundation .................... Prop. Line ......................41 REPAIR/ADDITION{Frau. Sanitation Permit# .........„..--. .._.--�-- .•............. Date ----------------- ....... (/ Septic Tank (Specify Requirements) ------------------------•-• s- •'-.._..-. .........------------••.....................-......._--........... ........ ---------_---..- i Disposal Field (Specify Requirements) .............r..€------------E ................................................ -----------------------------._..._.. .......................... i -.1.......... ..... ~....^ f�.._..--y-,tS r y�� '� f • � ,i� ... ... .... ....... . ..... .' (Drew existing and required acldition•on reverse side) ; r -_ , i I hereby certify that 1 have prepared this,application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of fheSan Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: 1 .. , "! certify that in the performance of the work for which this" ermit is issued, I shall not employ an P P y y Person in such manner as to become su ject to Workman' Compensation laws of California Signed ...... . . _. --------------- ------•- w L�^t _ - . .... --_... 7itl r.... _. ... . ...... ............ .... I (If other than owner) - FORDEP RTMENT`.GS! ONLY _ APPLICATION' ACCEPTED BY ,. =r DATE ..... ._. ....... BUILDING PERMIT ISSUED ,. .. DATE ...............:....... .... .. ._.. . // ,� . -- . eLi . . ADDITIONAL COMMENTS --- - ---:�Yllf---- -.T-------1�........ . .......�. --------.--•-- .. ..---....--- ----------._._._.._..............:..........---_......_. ....................Ct,y7............. ___ .. ... .. ...------.......__........................... Final Inspection by. r:.,:_.� = ... Date ._.. . SAN JOAQUINN 'HEALTH DISTRICT E. H. 13 24 t -.'Sr3 i,¢S Rev. 5M '` 7/72 3 X