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v, � , FOR OFFICE USE: - -� APPUCATION_,,OOR, SANITATION PERMIT (Complete in Triplicate) Permit No. -_ -__--__- ------- 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 .____2 Z-_1.70 - � p � / ill-p�N--------� CENSUS TRACT 1_ _'SSD d I Owner's Name �iC7�V--------QLD -----------------------------------------------------------------Phone Address --- 1v ...RA-PON--------R-D---------------- City > I P1j Contractor's Name - E ------- ----------License # ---------:-- ----------- Phone -----I--------- --- Installation will serve: Residence F-14artment House❑ Commercial :[]Trailer Court ❑ Motel ❑'Other -------------------------------------------- Number ------------------------------------ --Number of living units: 'Number of bedrooms lf.3------Garbage Grinder W0___ lot Size -A CR_1�66_F5------------- Water Supply: Public System and name --------J- Chaaract- r of soil to a depth of 3.feet Hardpan Sand;'❑_ -Sift-❑--..:.:.Clay []Peat-0—,Sandy-Loam= C-Iay�oar a # ,- �.. Hardpan ❑ Adobe-❑ Fill Material _V4--- If yes,type _____________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed ori reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} , PACKAGE TREATMENT SEPTIC TANK-- - ' " N [ [ a Size -------------y-------- - -- - 'Liquid Depth ) CapacitY�-------------------- T i Distance to nearest: Well Material- ________-___.__ No. Compartments; :__-.-- ll i � 1 -------------------- ---------------Foundation - ------------------ Prop. Line =-.. ------_--------- LEACHINGI LINE [ ] No, of_rines:I--r-ti__-„(----- Length of ach line______________ Total Length ___I__ _•I_- ---- -----,-•--- 'D' Box .`----------- T,y,pe Filter:Materialy- _- -------: _Deptf��Filfer._.Material--------------------I '-------- -------- Distance to nearest`:.,Well ______________________ Foundation ------------------------ property Line, ._____-- ___._____._..•- SEEPAGE PIT ;[ ] Depth --- -----'__ Diameter ----------- _,_�~- Number ------------------- Rock Filled Yes ❑i No ❑ i .Water Table ',Depth :_--Rock Size ----------------- s Distance to nearest. Well ------------------------ ---------------Foundation ------- Prop. Line i ) r -------------- ------- REPAIR/ADDITION ----.-_._----•- REPAIR/ADDITION(Prev. Sanitation Permit# ___ ---W ate Septic Tank (Specify Requirements) -- ------------------- 0 -- -0------- -- ) ----------------------- Disposal Field (S ecifY a qu'iiemehtsrt) �- tG X _-- ---l ------------ (Draw existing and required addition on reverse side) I hereby certify that I have prepared, this aptilication cind that'the work will be done in accordance with Sar; Joaqu, County Ordinances, State Laws, and Rules and Regwigtions o'ftthe`SdntJonquin local,.Health District.' owner or ficen sed agents signature certifies the foilowing: - _ � "I certiF t t in the perfor ee'of the work for which this permit is issuer!, I shall not"emp 44-any person lin such manner � as to be o e subject to War Compensation,laws of California."' i Signed n_ ---- Owner ,��-� � ' BY ------------------------------------- -------------- -- ---------.- -- - !R- Title -' 1� l t ----------------- --------------------- -.-----FOR ----- ------------- I other than owner! -_ - - j -- -- ,. ._ __—__ _F_OIt-_D PARTMENT USE QNLY APPLICATION ACCEPTED 13Y!_* V 1 �= ! '-4DATE BUILDING-PERMIT-ISSUED _.-.- -- ----- --- - Qj- I t �-- =d\C- - -"� /'! _ �` --- -.--D"ATE -- ---------------------------------- ADDITIONAL COMMENTS A--- _ _- -j _- / - --------- -------- - ------------------------------------------------=----- r T� ------ ------------------ ------ ----------------------------------------------------------------------------------------------- I incl Inspectio ------- r' - r - ---..Date ------- ------------ ----------- SAN. JOAQUIN -LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M .�A