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-f JT k FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . ._-- -------------------- ----- p (Complete in Triplicate) Permit�. - ---------- ;'t - /l T x � Date Issued : l' = --i- -- "- -- - fp From Date Issued $ Permit Ex ares 1 Year Applica eon is ereby made to the San Joaquin Local Health Distract for a permit to construct and instal! the work'herb in d'esc�ribed. Thrs application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations.' 2_ 13 ----- th - ------------ ------ -CENSUS TRACT -------------------- JOB,ADDRESS/LOCATION .---'.--- 331:-E �- -- ------ --- ------------- -- --------------- - Owner's Ndme .Q�ene_Ray_ and---Dorothy- Perry---------- ---------------------- ------------------------Phone.9' '8'.4'797----------- ---- Address --------------?3_31_- E•---9fih---- --------------------------------- -Is-- cit ---Stk1----.. ---"---------------------------------------------.r.... Contractor's Name .°Pn_ 3ppt1c 'I' tlk & het-der__IB.LIic�ense # 6 .' 37--------- Phone . 6 .^-$-7_9$-- ---- Installation will serve: Residence ® Apartment House❑ Commercial :❑Trailer Court ' Motel ❑Other ==' -------------------------------- Number -- -'=----`---------- + i Number of living units---- Number 'of bedrooms _-_3_---__Garbage Grinder _IID_____ Lot Size _-6{?;._.X---1-50t-__--_-_- .. ;- -� Water Supply: Public Sy tem and Warne = �' At `. QT'_ SeT'VGB_r±Q.__________________________________________-Private ❑ i Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay "❑ Peat❑ Sandy Loam ❑ Clay Loam t k Hardpan ❑ Adobe X] Fill Material ------------ If yes, type -----------------------I---- showing --- } [� `[PIt�plan,�showing size of lot, location of system in relation to wells, buildings, etc, must be .placed ort reverse side.) t ANEW INSTALLATION: [No septicitank or seepage pit permitted if public sewer is available within 200 feet, PACKAGE TREATMENT [ ] SEPTIC TANK:[ J Size------------------------------------------------ Liquid DepthJ-----------.------- �._-- G' Capacity -------------------- Type -------------------- Material_ -------- No. Compartments -------------------_-• 4 ,� � Distance tb nearest: Wel! ............................ ------- --------------- --•--_-----Foundation ---------------------- Pr �Line ---------_------- . I ^* t t LEACI111rIG LL. itEi No, of Lines .___l_________________ Length of each line______Q.________._..______ Total Length f S}______.______.___.._.,3 i 3 - f D' Box .-no---- Type Filter Material -_1`QQk�------ -Pep'fh Filter Material _.__.__________________�_ S { Distance to nearest: Well ------ ----------------- Founda aVn_P_ll --__ Property Line S IT [ Depth 16t -_ID&Xa_ Diameter V_XDV_/Nuri %Jk� �_"`_i _r_ .,Rock Filled-�Y.es ® No I❑ r i � - -- --tl� 1 � Ilv ; Water Table Depth ----35.__._p1u8-----------------------Rock Size_2_._._ 9__ `- 5 --� .{. Distance to.nearest: Well ----------------------------------------Foundation A_ �-.__ _._:_`'Prop. Lin REPAIR/ADDITIONi,{Prey Sanitation,Permit# ____________________________________________ Date ___-__-.�.__-:._:____ _j__±____) 1 { JI V`, , 14 Septic Tank {Specify Requi�emenfs) _ \ ---------- -"L--------------------------- 1 �� a p ° t 1 v - 'p - ' p # ----- ----end- Off_-exist-Ing-_1_0ach.--arid_ Disposal Field S echf Requirements), &ddIng 4 Q , D 1_ n ' - - fp+ adding 2=--x-W'i" m l t ' 7 I i--------------------------------- --------------------------- F Draw existing and required addition - --------------------------- I # +i. ( �.g q dition o Breve se side) t, I hereby certify that lihave 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 lice'n- used agents signature certifies',the follokfar i• ti 'L certify that in the perFormance of th this permit is issued, I shall not employ any pets in such miner at'to become subject to WcAman's Cs of California." Owner Per -- -- - --- ------------------BY -r - ------ Title -----0-ontractor------------------ p thiRif FOR DEPARTMENT USE ONLY ---��--� ---- - --- t _ of o� Wer] APPI-6T'iON ACCEPTED .... -172 :W `== _. �, -��,._ =' ' DATE x�_ __ . ._-- BUILDING "PERMIT ISSUED ------------------------------- -------------------------------------------------- -------- -----"GATE -------- ----•; } ADDITIONAL COMMENTS --------------I--------------- - '� ':. ---------- ----- '-_'_ ------ ------------ --------------------------- ' = ----------------------- -'-- - --- -------------------------------------------- ---------- ---- ----------`--------------1----------- =-----------{--E--- -r` - Final Inspection b /� - _ r-f` 'w. t P Y --------------------------------------- ---- -------- o"� ---- ----------.Date - -1]j}------'------�--�- -�--------�---- SAN JOAQUIN LOCAL HEALTH"DISTRICT 3 E. H 9. 1-'68 Rev. 5M