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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �y� -- - ..._. ------------ ' - .._...,.�...r...-.Permit,.No...70766`� .. -r- �`-a. (Complete in Triplicate} G This Expi res 1 Year From Pen ' Date ls`sued 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: d �i � E/ SD _. i�' -LtNSUS TRACT __- ------ --_--------- JOB ADDRESS/LOC TION --IDg4r .A10,I f - / .....- Phone_Sr�7 -g. _l.-S�-- ---- Owner's Name QPE /�� .- .7Fr�=�! ?�/- ........... ...... Address . City Contractor's Name --_. -- --------- ..-_.License # ---- __._.. Phone ----- ------ --------------- Installation will serve: Residence ❑Apartment House fl Commercial❑Trailer Court ❑ Motel ❑ Other -----..- ' ,Z, 'Uo _. . Lot Size 3/ C,2 S ---- .. Number of living units:.. Numb'er-of bedrooms, ____. ______Garbage Grinder _-.. �-- Water Supply: Public System and name -.- ► Private 4 .. 1 ; Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay El Peat❑ Sandy Loam ❑ Clay Loam tHardpan ❑ Adobe ❑ Fill Material ___ _ - If yes,type ____ .. . ...... .... (Plot plan, showing size of lot, iocatiori 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 is available wit'hinf 200 feet,) r \ —' ' SE IC Size._.y-x_-5 X-� ---------- ------ - Liquid Depth ..__---.........•• PACKAGE TREATMENT [ I _ [ ). O Capacity Type _ Materiol.O/0W No. Compartments ......----_--__-:____ ' Foundation -. ...___ Prop. Line 3.P..__--__ Distance to nearest: Well / ---------- ---------- - I 72' ten th of ach line......7s - Total Length LEACHING LINE [ ] No. of Lines __-_-_ .... -_- Length _----__ Type Filter Material /CA .-- -Depth Filter Material _� ..- --- 'D' .Box .� f Distance so nearest: Well .��_�_..-__- .. Foundation ___ _ .--.:.Property Line ._ ................... Number ---_...._- ...__. . Rock Filled Yes ❑ No SEEPAGE PIT r ) Depth ............ . Diameter -----.._. .- - -•- Water Table Depth ..'.-. ------- ------ .-_---Rock Size _......_. Distance to nearest: Well _________ _ ____________________________Foundation .....:.__.__._.... . Prop. line _.-_......---...-___.. REPAIR/ADDITION(Prev. Sanitation Permit# ................ _. ---- Date ............................. ---} I ................ Septic Tank {Specify Requirements I ) .... - Disposal Field (Specify Requirements) _ ............. ....................................... .... - ................. ... ------ ---.. .. ---------- ..... (Draw existing and required addition on reverse side) I hereby certify that I have Vprepared 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: "1 certify that the performance o the work for which this permit is issued, I shall not employ any person in such manner as to beco ct.10 VdkrWa Co pens ion s of California." Signed .. --- --- ----- - ------ ..- Owner BY I Jitle - .._ ...-. -- --_... ---- -- ------ -------- -- -------------- (If other than owner) I FOR DEPARTMENT USE ONLY --w APPLICATION ACCEPTED B Q/y' -------- -------------- MIT DATE. .7r ................... BUILDING PERMIT ISSUED __ ...............DATE _-__.._.. ......................... _----- ---- .--------------- ADDITIONAL COMMENTS .............................. ...................••--......_........_..- -- - --- ------------- ...... . ----- --------- -- ............. ...... --------- t -----•-•----------- - ............................ ----- . ---•------... .........-•--..._....•--- .---- ... -._.... -- ---• . - Final Inspection by: .... - . .. ---------- Date SAN OAQUEN LOCAL HEALTH DISTRICT E. H. 9 7-'68 Rev. 5M �