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FOR OFFICE OSE` R APPLICATION FOR SANITATION PERMIT -----------•----------- Permit No. --7----0------- ^ (Complete 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -----�'R_ -D-----------------------------------CENSUS TRACT --- -- .-t -------- Owner's Name ��_ 1 _ -------- ,,�rjo_ = -------------------Phone --------------------------- Address -----r-�- `7/_-•-6.2_=_C'---------60--------U1,V-I�_Q'_t------------R-D`-- City �_�.1L��.� = --- - --•--------------- Contractor's Nome,, . -..E,.-..-CqR_&B-�,E---------------------------- ----------.License # ---------:-------------- Phone Installation will serve:'.. . Residence �artment House❑ Commercial :❑Trailer Court ,❑ Motel ❑Other -------------------------------------------- - r Number,of living units:----- Number of bedrooms _;Garbage Grinder M-0.___ Lot Size __ C _ ------------- Water S upp I y- -----'____WateSupply: Public System and name L- - -------- ----------------` =,-------------------- ---------------------------------------' P.rivate ]' Character of soil to:a-depth of_3 feet: Sand'❑4:.y Silt❑ Clay .❑ 1 Peat❑ Sandy Loam •Clay Loam Hardpan ❑ t Adobe '❑� If yes, type ------ ------------------ (Plot ----- -------------- --(Plot plan, showing size of lot, location of-system in relatio,to wells, buildings, etc. must be placed on reverse side.) t NEW INSTALLATION: (No septic tank or seepage pit permitted.•if ublic sewer is'available within 200 feet,) �r V PACKAGE TREATMENT [ ] SEPTI '{(.]�''� 1- Size __A_3Q_ ______'Liquid Depth PAC IC TANK Capacity -------- Type C'13, F MaterialNo. --- Prop. Line ---5-----•--: Compartments -______'�:..__._ Distance to nearest: Well -------- aD ----------Foundation __�f __'�`_ �` - - ------ LEACHING LINE [ No. of Lines --------- Length Length of each line -_---------------------------- Total Length :___�4�20----£........ . 'D' Box /Y�SType Filter Material __I'2_aC1_.Depth Filter:,Material ---- __.______-_-`--,_-.____._ Distance to nearest: Well __. __'t" ___ Foundation ,Property Line �h SEEPAGE PIT [ J Depth _____..__ ---------- Diameter ----------------- Number ____________________________ Rock Filled Yes ❑ No i❑ Water Table Depth -----------------:`--------------------- I-----Rock Size -------------------------------- Distance to nearest: Well ----------- ---------------------------Foundation -------------------- Prop. Line ____...._..._-..__..__ REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date ------------------__.______-__.-__) Septic Tank (Specify Requirements) --------------------------------`----------------------------------------------------------------------'--._..-- ----- DisposaE Field (Specify Requirements) --- ( P _ C .____, 4 -------- filff .___..U1`_f _ --------- ------------ \6- --------- = --------- --------------- -F----- � �I -------------------------------------- ------------------------------------------------------------------------------------- --- ------------------- , ---------------------------------- (Draw-existing and required addition on reverse side)` l I hereby certify that I have prepared this; application and that the work will be done din accordance with San Joaquin County Ordinances, State Laws,rand Rules_and,Reg ulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the perform a of the.work f which this permit is issued, t shall not employ any person in such manner as to beco a ub' to W an' Corripens laws of California." Signed --- --r-- ------- --+- - - -- --� Owner B ----- Title _>..� (if other than owner) FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY ------F.--R-` -r---------------------------------- ------------------------------------ DATE -7------------- -----------PERMIT ISSUED.__-__ -DATE .---- _._-__f________ ADDIT-IONAL COMMEN. .- - — _ ". _ ----_-- . = -- - - -- --_-_ -- - -------------------- _ of _ ,� ------------ ------- _ —- ------------- ----------•--------------------- ._---- -- ----- ------- - - -- -------------------------------------------- Final lnspec 'on b �� - Dote --- -- ---- - - ----------- SAN --------SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M