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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT 9�y ........................................I................ Permit No. . ..�...... (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 .....¢-l�v�.......451.------- ..�T��...........................CENSUS TRACT ..................... Owner's Name --- .-'8C?13--------- -&S190 .....Phone ...r �`c�:. ... ... . J I_ Address ..- ..... o�-� 5 .......... AST .. � City .._.._ 1" J.- ................... ..............._ Contractor's Name ----cewl �4.'.......... � �.4'T!�td� .4....------.License # ...............--- ---. Phone _.443-t J�S Installation will serve: Residence Apartment House C] Commercial❑Trailer Court 0 Motel ❑Other............................................ Number of living units-------/ Number of bedrooms ............Garbage Grinder ............ Lot Size ................. Water Supply: Public System and nameCom!.-_._4.Ak .....Private Q o Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam jj Clay Loam ❑ � Hardpan❑ Adobe Z Fill Material ............ 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 is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK i ] Size--........................ ................. Liquid Depth .......................... Capacity -------------------- Type .................... Material..........------...... No. Compartments Distance. to nearest: Well ....................................Foundation ... Prop. Line LEACHING LINE [ j No. of Lines ........................ Length of each line............................ Total Length ............................ D' Box ------------ Type Filter Material ....................Depth .Filter Material ...........................................I Distance to nearest: Well ..... Foundation ............ Property Line ........................ SEEPAGE PIT [ [ Depth .................... Diameter ... Number .................. — Rock Filled Yes ❑ No 0 WaterTable Depth -•------•..................•--•----•-•--....._..Rock Size .... --._...... ................ Distance to nearest: Well __.....Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I Septic Tank (Specify Requirements) ---------------• .......------ ter. A- ...... ... Disposal. Field..(Specify .-Requirements) a ................30 :-----------_. ---:---•----------------------- --------------------------------------------------------------------•--------------------------...------------------•----------•----•------------••-----••-----••-•---•-•-------•----................. (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;Dlstrict. Home owner or licen- sed agents signature certifies the following: "I certify that i the performance of the work for which this permit Is Issued, I shall not employ any person: In such manner as to beco blec W kora ' o nsation laws of California." Signed .-. V. �- - - ----- -- .... � Owner BY -----"•------------- ------------------------------------- Title -- .----------- --•----- .... ------ -------------------......... Ilf other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...................... ... ............. DATE .". -.Z. - --------------.: BUILDING PERMIT ISSUED _.. _- ..--...... i DATE ..... :............. ADDITIONAL COMMENTS --1 - - ;_._..-_.-. ............... Ti7.F zz• - - .................. ........................................ -------------------- ----------- ------ �• ------------ ------------------------------------- - .........------. --------...---••-...... Final Inspection by: ----- ....-. ..... .................. -•--.-.-.,....- .. .............. Date . ` (�--------......... EH 13 24 1-68 Aev. 5M SAN JOAQUIN LOCAL )"HEALTH DISTRICT 8/74 3M