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FOR OFFICE USE: ---- APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. -. Date Issued /4.1)___�3_76s/ --------------------------------------------------------- This Permit Expires 1 Year From 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: .SOB ADDRESS/LOCATION -------- - ------------- ----------'- ---------1------ ENSUS TRACT --------------.-------._.. or X2 Owner's Name -- ---- � <t[�% Phone Address -------------------------- ---------- - - -------- �T� itY Contractor's Nam ---- --- - ---------- --+t{_-- � - - � -.License # d ��__ Phonelp .-- Installation will serve: Resi enc e A artmen'f H m .) p ouse�❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ________________ Number of living units:-- Number of bedrooms4` A ��77 ' g �------ -�--Garbo a Gr'ad ------------ Lot Size -----------------� ! -- ----------- ---- -- w ' Water Supply: Public System and name __ Yfli 1 z____............................... ___ _ ___________________ __Private ❑ Character of soil to a depth of 3 feet: Sand'❑ ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe Fill Materia! ------------ If yes,type ___________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer iVvailable within 200 feet,) `� PACKAGE TREATMENT f ] SEPTIC TANK Size_ _ _ -- ----- Liquid Depth - _ __-____ Capacity f- 0-0 Type6*actA____ MaterialAP-r- �__ No. Compartments __ ----------- Distance to nearest: Wel! Nv --r-----------------Foundation -4-0----------- Prop. Line ______4�________ r�r � LEACHING LINE No. of Lines __�-------------------- Length f each line- l_1�_r--- ------ Total Length �-o--- -------- W Type Depth Filter Material - D' Box ____________ T e Filter Material __ _____ Distancetonearest: Well -NCH--a----- Foundation 40---�__-__--_--- Property Line ---------�_77 SEEPAGE PIT Depth r____ DiameterZ _�_�____ Number -----I-_____________________ Rock Filled YesK No [3 Water Table Depth _ E� r �L << �r P -------------------------- -------Rock Size -- 7- � -�-- ----- llam� __ � Distance to nearest: Well __±'t_D _ ---------------------Foundation ----7 / -__ Prop. Line _...__J ._...... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) --------- ------------------------------------------- ---- ` - Disposal Field (Specify Requirements) ---- --- -------------------•------------ --- ------ ----------------------------------- --------------- --- ----- - -- - - - -- - ---- --- ---- - ---- ---- ------------------------------------------------------- -------------- ------- ----------------------------------------------------- -------------------------------------------------------------- (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. Home owner or licen- sed agents signature certifies the following: f�. "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 toec ubject o Wo mane's Compensation laws of California." ---------- Sign e --- - - -- ------- ---------- 0=- � Title -- -------------------- ----------------------------------- (If other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- 1 ------------------ --- DATE DATE - Q-- ------ BUILDINGPERMIT ISSUED ----------------------------------------------------------------- ---------------------DATE _..----------•----------------------------- ADDITIONAL COMMENTS -------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ----------- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ - - - - - ---------------------------------------- ----------------- ---- ---------------- ------------ -- - -- Final Inspection by. F C,1 - Date _ L5 SAN JOA QUIIv LOCAL HEALTH- DISTRIC- T E. H. 9 1-'68 Rev. 5M