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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT-- --- -------r-------------------•- - Permit No. ._./.�""/7y ---------- - - --- i (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: u C JOB ADDRESS/LOC ION ._ !_ 5--,--� - ------ � _ _ _ ---------------------------------CENSUS TRACT --J-- -----.- -. Owner's Name _ _� , NFf�_�;r-� ------ Phone Address -� E.--------OR h}_N��=-------------------- • . City -- C - --- ---- - -- - Contractor's Name ----Qt.(AJ1E-f�-------------------------------------------- ------.License # -----1_;----------------- Phone --------------- ------_--•-- Installation will serve: Residence ❑ Apartment House❑ Commercial :❑Trailer-Geuft-j Address City Water Su ( i pPly: Public System and name ------------------------------------�---- - - - - -------------------------:---•-- ---------------------Private 0� Character.of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat ❑ Sandy, Loam Clay Loam ❑ ' I F HardpanE __Adobe.❑-_FiIE Material,_ a__...If.yes,type -- - (Plot plan, showing size of lot, location of system-in relation to wells, buildings, etc. 1must€ be placed :on reverse side.) NEW INSTALLATION: (No septic tank or ;77 a pit permitted if public sewer is available within' 2001eet) V i� : + fr PACKAGE TREATMENT SEPTIC TANKSize ___ /_© 5G ___, _:_c._'_______ Liquid Dept�i'_____- " 3( � _ � Capacity -�z-�- Type 13 C�QSr Material_C_?`CRT__.--sem No. Compartments ___fir.:... Distance to nearest: Well ____ �Q._�:�'______-------Foundation'/P---/_____________ Prop. Line ---S_r___:__._._.. LEACHING LINE pl- No. of Lines -----/-______________ Length of-each line____7, `__- - Total Length ----7S_-�_________. ----------- ------ ' 'D' Box /VrO.----- Type Filter Material _Ra C,/'-�_Depth Filter_Material- ------ g______________________________ Distance to nearest: Well ---/DD _' _r Foundation ________________ Property Line ------------ SEEPAGE _ _SEEPAGE PIT � Depth _/---------------- Diameterf_X-Y---- Nume Rac Filled Yes No Water Table Depth ----- - Rock Size x-_-_Z__ __. r. Distance to nearest: Well ----1190--------- -------------------foC�ndation _=1Qs_ _ -__ Prop. Line ----__________--__..-_ REPAlk�-ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ------------------------------- Septic _____________________________Se tic Tank (Specify Requirements) i ---------- Disposal Field (Specify Requirements) ----1 S-Tf L - _fes.-------F--kQM---------4?bkF--_._S 10— -----------------------•_---------- ---------------------------------------- ------------- ------- ---------- , ,---------------------------------- ------------------------ ------------------------ ----------------------- ---- -- -rte_-,_- s--- -- ------------ ---------------- = --- ---- --------------------------------------------------------------------------------------------- `(braw existing and required addition on reverse side) - 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 District. Home owner or licen- sed agents signature certifies the following: f "I certify th in the performanc of the work for which this permit is issued, I shall not employ any person in such-manner as to be to Wor 'f s C nsati.on laws of California." ra Signed ------ Owner ✓ . z By --------------- --------------------------------------------------------------- �`- -r-- Title ---------------------- r --- --------------------------------------------- (If other than owner) _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ - ------�--"- -- -----------------------------© DATE 3 4_1 4�_ BUILDING PERMIT ISSUED - - - �: -- -- # #�1 --- - 5 _1=C : = - - DATE -_- `------------------- ADDITIONAL COMMENTS -------------------------------------------- ------------ is = =~ - P ---�°�------ivo"--------------------- - =_�iv5----- �- CO OT' `------- 1T t� PTff-------M_a `-- Cff�K ? ------i�D)d---„4oT__�--4,rL___FQ-fk---1nis --- --- --- _ . ._. . - ----- Final Inspection___ - - .� ""x--- SAN JOAQUIN LOCAL HEALTH DISTRICT Date+ QqC -F-D M t:0,C3i tjF_15-x' (T) �l-EASE E. H. 9 1-'66 Rev. 5MI4) NO-7- f/fiN'7' `i-O PDP R�C{L i✓-7`� .�