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J FOR OFFICE USE: " y APPLICATION FOR SANITATION PERMIT i23� .................-•------- - ----------- ------ 'Complete in Triplicate) Permit No. �r•--------_.... ............._--..----.....--_--._.--. 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 constrxwt and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: l JOB ADDRESS/LOCATION --::2'3__ �-•.------�p -(-- -.DOVI]S----------R-_D---------•-----CENSUS TRACT ---.- Owner's Name ------ At - �IZJk7 - ---•--------:-------•--------- -------------- ---Phone n g;R �. �j n t Address _-.2-3-TOO 1/-V.V-D-"S----- - ��}..t1 ......c(ity ---F CALN--•------------------------------------- Contractor's Name Ticense - Phone ....... Installation will serve: Residence Rrx;"ent House CommtI railer Court I] Motel ❑Other--------------------� --------=- --- ` e Gri6der Lot Size .. R � ........... Number of living units:----- _ ------- -- -------- Number of bedrooms Garbage Water Supply: Public System and name -----------•---------- .......... --------•----------------------Private®� Character of soil to a depth of 3 feet: Sand n Silt❑ Clay ❑ Peat y Sandy Loam 0 Clay Loam F9 , _` -�Hardpon Adobe❑ Fill Material rr-�__ 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 r4p, pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK' �� Size_?XL�.X_ --------------- -- Liquid Depth .__________________ �I)�© T �C� Material__ NCRT_ No. Compartments stance io-nearest: Well ...... -` __..._-..Foundytiop ---_ Prop. Line ?c .. LEACHING LINE [ No. of lues _.__ ______... Length of each line__ ^=_.__{Tatat Length ___ Gc �, = � y D' Boz/Y�_ Type Filter Material . .__-__-._�_bepth Filte� Material ------------ --T ------- / ` '..... Distance to nearest: Well ... ._''t.— Foundation _._� .T"_.._. t�Property Line .._.,?�_. b ! C� SEEPAGE PIf �[ �`'� Aepth _.�_ _. _ _ ._ DiameterzQ-K'_��.-. Number --------(Rock Filled Yes No �1 Water Table Depth __ I Rock Size ------ --------;---i----------- r---Distance to eares We11 ..___..___-.___-.1'�`_. ' Foundation _..)-- Prop. Line -- ' -------- Date ----------------------- -- ) REPAIR/ADDITION(Prev. Sonit tion Per iit�---.---------•—_ - '•'- `. Septic Tank (Specify Requirements) i------------------------------- TTI ' Q Disposal Field (Specify Requirements) .,__ Cls;_;---, - � i-- - `' :'tJILI� J ---------- D------- ^- _.---------- { -�-�-� {_ x _7---------------------_----------------------- - R- L; �> (Drew-existing and required--addition on,reverse side) i3 I hereby certify that I have prepocec! this application_and that the-work-'w be done in�actordance with San Joaquin County 04niinces, State Laws, and Rules and Regulations of the Son Joaquin local Health District. Home owner or licen- sed agentssigiiature certifies the foil "I certify t� the perfor ace of a ork for w h this permit is issued, I shall not empj�aay Person in such manner as to liec a b)ect to W an's o ensation s of California." Signed.. .. -- ------•------ ------ Owner 1 `-7 - Title - ----------•-•• ------•------------ ............... ------ fi If other than owner) 11 _4 s FOR DEPARTMENT USE ONLY APPLICATION 'ACCEPTED BY_...._�Nt--- ��----------------------------------------------------------------------DA � . :.__-.L BUILDING PERMIT ISSUED --------------•-------------DATA_..`..-'.._.. ADDITIONAL COMMENTS----- -••---•................ ..t.... 'T - - - _ _ - --------—- t... •-----• - - - T= =-- r _ -- -- ---------------•----..._ _ ------------- ----------- :. - �1 ------ 0 -- - ------------------- . `t`, Final Inspection _ ._.--- SAN JOAQUIN LOCAL HEALTH DISTRICT E.H. 9 1-'68 Rev. 5M