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FOR OFFICE USE: APPLICATION FOR. SANITATION PERMIT ......................................... 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 per to construct and install the work herein described. This application is made'i in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ,.-..I 447-3�� S.........W19_Tx.N.E.R............................CENSUS TRACT .... '..-�.�.......: Owner's Name ...............)3,14. lQl ........................ :.....................Phone ................. ...... ` Address .....................l l`.� ...... ..------.W,6��_.N�_k...... Ci y . _LP .........................:...... ................i . Contractor's Name 10W.N. .....................................................License # ...... Phone } Installation will serve: Residence E!rApartment House 0 Commercial C37railer Court Motel ❑Other ..... f .... Number of living units----- Number of bedrooms __. d• Garbage-GrinderyAE.�._ Lot Size C .E14 . . .... . . .... ........ Water Supply: Public System and name I l ••-•-- _.... -- Private �! W ,�. Character of soil to a depth-of.3 feet: Sand -Slit Q= ;I lay ❑- Peat Sandy Loam e. Clay Loam �]- . - Hardpan ❑ Adobe' Fill Material ..Q-- If yes,type ............................ (Plot plan, showing size of lot, location o€. systern" iirelation to�weiis, buildings, etc. must be placed on reverses#de.) NEW INSTALLATION: (No septic tank or seeps i>permitted if public sewer is available within 200 feet,) _ PACKAGE TREATMENT [ ] SEPTIC TANK� Siae.... [� � x.1to.....k................. Liquid Depth .J ....'.......... Capacity 7ype Pt3E7GOS-T-Material..CQ!VCR.—No. Compartments Distance toearest Wel{ -------.IB ... +........Foundation .........I.'}:.....- Prop. Line ._.�..�....:��_.... LEACHING LINE {'� No. of Lines^ -. _-_...--._...- Length of each line.__. ..r ....._.. k �� _7� Total Length ..�� ....._. -Type Filter Materiel D 'D' Box/ _K.Depth Filterr Material ..... .17..................T........... t tDistance to nearest: Well -l...D _..+_. Foundation / ..=t'....:.. Property Line _ ............... SEEPAGE PIT'—(s)-"`"""eDepth .'" " ._.:...._ biprrieter .}........ Number ............................ Rock Filled Yes [3 j"vNo C3 LAI Water Tab e�Depth ........................ Rock Size Distance to nearest: Well ................�................._,....Foundati n .................... Prop. Line ............ REPAIR/ADDITION(Prev. Sa itotion)Permit# .................. ................... Date --------- ....................... r I Septic TcrAkr(Specify'R gvirem ts) :. ................................ .................................... _...... Dispossol I Field Specify Requirements) ................................ �. (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,,!Q`Rules and itegul iflons of the San Joaquin Local Health District. Home owner or licen. sed agents'signature certifies the following: ) t "I certify t the orma c of11 eIth6eork for which this permit Is issued, I shall not employ any person in such manner as to beco a bi W r n'sensation laws of California." Signed - -- ---- . ....-----•--•---•-•-•• -- Owner........ .... By !) tie Ti ` llf other than owner) # r FOR DEPARTMENT USE ONLY n y - APPLICATION ACCEPTED BY ......... S1?. k..........................................................................I -DATE ...._. . 77J:7:• .......'. -•--- BUILDINGPERMIT ISSUED .._........-•..........................••---.........................--------------------•-•-_.._.........DATE ..................... ..'.•............. ADDITIONALCOMMENTS .... ....... ....................................................................................•.............................:........................... ---•... ....... .....'.... ---- .. -- .......... .......................................... ._... ......... ....... Final Inspection .. --• --------------------------- .Date .._... ..._.�..._. ...... ... ..... SAN JOAQUIN LOCAL;HEALTH DISTRICT t s E. H_13 241.'68 Rev. SM 7/72 3-M