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FOR OFFICE USE: r - ---- APPLICATION(Comp" SANITATION PERMIT -•------------------- p n Triplicate}. Permit No. -- _1c-. ___________________ This Permit Expires 1 Year From Date Issued Date Issued _ ------ Application _-_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 .-----S-O ?-----E------PEA-[-0----------AV�-------------CENSUS TRACT -_- _'_��------- Owner's Name -(fL.19_y_Tol�'------�---------j3-0R-C 14C=-�--S --------------- -- ------------- Phone --------------------------- Address C22 ________" . 1 H-1tSr�+rrrv' " - , Ac ----fig. ~l� ► _� Contractor's Name 1�1f1 --------- ------------------.License # --- ------------------ Phone ---------------------- Installation will serve; ResidenceXApartment House-0 Commercial ❑Trailer Court ,❑ / Motel ❑ Other - --------------------------------------- Number of living units:____r-____ Number of bedrooms ______Garbage Grinder��_ Lot Size ---!'f-CR-E}�_a� —_-.._.-_- Water Supply: Public System and name ____________________,___________• _--" _______Private Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat Sandy Loam ❑ Clay Loam ❑ F -- - _ -- -Hardpan . p ❑ Adobe ❑._.F.ill Material _ �,--._!f."yes,,type.-.-------------- (Plot ------ -- --(Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: 1 (No septic tank or seep pit permitted if ublic sewer is available within 200 feet,) PACKAGE TREATMENT aa"11 ��(/0 *-X----- ------ Liquid Depth ---- -- --------- [ SEPTIC TANK [ Size-___ __ _________ '2— U Capacity _1 _ dType P STT Material-c4_/4(RT_`__ No. Compartments ----- ................ f istance to nearest: Well"-il---------- ______ __ ______ o ation _ Prop. Line ----- --- LEACHING LINE No. of Lines ___ . ` i ngth of each line Tota) Length ---- •-------•-------- rr D' Box � � Ty i ater�al RpC_A _--Depth F erg aterial -------�_ Distance to n st ell _-- `___ Fou ati I Property Line ----i --- ------ ---- - ----= -- SEEPAGE P17 [ j Depth % iamet r _. Ir -_� --- ------- -------- Rock Fil ed Yes ❑ No 3❑ Water a e De `h~ -------Rock S e - ------------- Dista ce one rest: el ____ )Fo ion _____________ ______ Prop. Line _----.___.___...- REPAIR/ADDITION.(Prev.:5a its ion_P ¢ _____._ -1 e ------------------------- ----- } Septic Tank (Specify Req ire ients) --------------------------------------- ------------_ p (Specify 4 nts ------------- ------- "� ---------- ----------------------- ----------------- ------------- �;� / ----- '" - is osa 1e u me v i . - r ' I ------------ ----------- (Draw existing and required addition'on reverse side) .�•.•�' I hereby certify that 1 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 follo*ing: "I certif n th .perfor nce he work r which this permit is issued, I shall not employ any person in such manner ` as to co sub to Vma ompens ion laws of California.” Signed \ - -----_ Owners I By -------- -------------`---------------- ---------------------------------------- r - _-Q Title --------------- (If other than owner) > ��—" FOR DEPAttTMENT USE ONLY APPLICATION ACCEPTED -5Y .___ -{-.!R-`-0------------------------------------------------------------------------------ DATE ----- .L . - ILDWG PERMIT lS5lJED_,-_,-._., ,_ ---a-,---.—_---------:�_•-_--- ----_:_-�:,y<---- .---- - ---- - --------�:�ATE -- ---:----- ---'--------------- - - - -. ----- --- ADDITIONALCOMMENTS __. :_ ------------------------ -------------------------------------"------------------------------------------------ 1- i i i ► --------------------------------------------------------------------------------- r..--------------------- -------------------------------------------------_---------------------------------------_---------------------------------------------------------------------------------------- . Final Inspection by: ------------------------------ ----------------------- -----Date ------------------------------------ _-------- SAN JOAQUIN LOCAL- HEALTH DISTRICT � 1 E. H. 9 1-'68 Rev. 5M