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r + FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3 DS/ P&rnit No. . 7 1Complete in Triplicate) "'-- ...............•--....................................... 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 complionce with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... (t .......... ... . ......._. .._.. . ...... . --CENSUS TRACT .......................... Owner's Nome ..................PA!Yl.P.. L�.IKK_ca>e 4. ----- --------- -------Phone 6`.F._..6 i z.z Address .6!7-...Sm, ..�I�v'f!'cs- City ,� t�Kzo r� ... ...... ..... ..... ...... . ,p .................................. .......... Contractor's Name .. .... ...b:..4: .' A�"tS/E-.�--.Sov�s-r -�' License # �S`F3Y-3.--- Phone 60.7......... y Installation will serve: Residence [AApartment House'(] Commercial -]Trailer Court ❑ jI t Motel []Other ---------------------Number of living units:.. M.. - . Number of bedrooms _----_.-Garbage Grinder _ -_... . . Lot Size .... c' '! P` ................... i Water Supply: Public System and name . ................................ .......... ................. Private { Character of soil to a depth of 3 feet: Sand 0 Silt❑ Cloy_��Peat 0 ; Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ............ If yes, type _- .- .-_. . (Plot plan, showing size of lot, location of@system Jn relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: ,t(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK Size..:_.:4KPP.- - ..... Liquid Depth .._s'54I........... Capacity ./Z`� Type ?Ft -(* f- Material.�o"�-`'� ,. No. Compartments Distance to nearest: Well ��Qr--- -----------------Foundation .. ..1a"_.°�..._.. Prop. Line --.-.'`^ -I_ ....... No. of Lines (•1 LEACHING LINE C� � . Length of each line ... S S�.... _ . .-.- Total Length ....f 70..`_..--_-._._.... ,p •D' Box .(. Type Filter Material --. ....Depth Filter Material .../R."� ............................... T Distance to nearest:`Well ......._- Foundation ........ Property Line r SEEPAGE PIT { Depth a �.._...., Diameter .--- Number ai_ Rock Filled Yes gJ No 0 . . - Water-Table Depth"_.35."-�---------_--- ' ..�. ---------------------------------Rack Size ..----------.._..-•---.......--- P Distance to nearest: Well _-.-0f ''..__.-_. -_-_.-.-_.-_-.Foundation ........ . Prop. Line .............n REPAIR/ADDITION IPrev. Sanitation Permit# ........ ... ........................... Date ...................---------------) Septic Tank {Specify Requirements) ................................ - • .......................... ...................... -............... . Disposal Field (Specify Requirements) ----- ------ ----------- --------- ------------ ----- .............. I .. -- ---•-- _.. .. .............. ------ ------------------------- ......... .......... ............ (Draw existing and required addition on reverse side) I hereby certify that I 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 the San Joaquin Local Health District. Nome owner or licen- sed agents signature certifies the following: "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 to Wo kman's Compensation laws of California." Signed .... ........-- Owner BY . . ... ...... ....... ..------......------ Title !l. . - --- -- -- (if other than owner) MENT USE ONLY APPLICATION ACCEPTED BY . � -- ---. DATE ..�i.. BUILDING PERMIT ISSUED _. . ..-- .. . •.................... . ... .. ...........DATE ADDITIONAL COMMENTS ......... If= =73 , s - -- ------------------------ ----------------------- -------------------- ------•-•----------------------------------------- ----------- --------- ---------- .... -- •- - - -- ....... -- ----------......---- . ----------------------------------------- ......... Final Inspection by: ..- -----------------------•---.- ...........Date N J AQUIN LOCAL HEALTH DISTRICT E. H. 13 24 1-'68 Rev-5M 7/72 3 ,K