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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- P P ..7.1..'c�1.7...... (Com plate in Triplicate) Permit No, This.Permit Expires 1 Year From Date Issued Date Issued.. ii7 Y 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 __.___ 15Q..1�IQXtk1..F�7 1Qt. ..B4 Sj.,...IaQG 4' OX(�.......CENSl15:TRACT _...S'�7......-_... Owner's Name .......Aonalil-R -.-and..Star.jeae...LjLiela....................--:.....................Phone-3.6.a.-9972............ Address ...105- So4th-341gg0--Street--- - - - --- City .....J'odi,---- A............ ......................._ Contractor's Name ........................................-•------ .............................:........License# ---...............--.... Phone ---.-----------..-............ Installation will serve: Residence ®Apartment House{] Commercial ❑Trailer Court Motel ❑Other ----- - .._.... . . ------ Number of living units:....1...... Number of bedrooms .......Garbage Grinder .....I..... Lot Size ...5.._aCT.eS...................... Water Supply: Public System and name ..... --------....... ..............-..--..-.._-.........---......--....... ........ .......Private ER �t Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam fN Clay Loam❑ `^ Hardpan ❑ Adobe'❑ Fill Material ....... If yes,type.........__..--------_..--. L� . O (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 [ T SEPTIC TANKjFl Size-S._.C�.J�17.� �.....__............. Liquid Depth r..:..... / _._.__,..-.. Capacity, .n.. -._ Typ2..�.�A vt.f., Material.. its-vI�` No. Compartments 1P r--------------- i Distance to nearest: Well .�6.�.......................—Foundation ...lf/.'..---------- Prop. Line ...... • LEACHING LINE [ j No. of Lines ...�................. Length ofeach line.....1,2.0............... Total Length .�_�.............. 'D' Box ��... Type Filter Material .�/.i.l-�.----Depth Filter Material ...�,l� J9 ................. I Distance to nearest: Well ---.cr.Q.........---- Foundation ...... .......... Property Line. ... fJ .......... SEEPAGE PIT [ ) Depth ........_-........ Diameter Number ............................ Rock Filled Yes ❑ No ;❑ Water Table Depth --- ---------------..........................Rock Size -...-----------------._.._.--- Distance to nearest: Well ...................................._..Foundation ................---- Prop. Line ............. ------- REPAIR/ADDITION(Prev. Sanitation Permit#_--...................._..,.....__.._.._... Date .........................---------i Septic Tank (Specify Requirements) ......................-...........-----------•...............-.....................-........... ......_...,.............. -----....--- Disposal Field (Specify Requirements) ... - .............--------- .................. ..........------------- ............--,........................ - ................ ... ............................. .............................................................-------•---....... .. . . ...---------------'--....................------. i (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 Son Joaquin Local Health District. Nome owner or licen- sed agents signature certifies the following: "I certify that in the performance of the workjor which this permit Is issued, I shall not employ any person in such manner as to becom ect W m s f CaJt mia." Signed .----- t .. -- .... - - -.... Owner Byx............... - ------------------------- ------- -` ...................... ......,... Title ----------- ---.... (if other than owner) FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY _. . ... . - ---------------------- ......................... DATE .............. BUILDING PERMIT ISSUED ............ .............. _--DATE .------------------------_-------.----- ADDITIONAL COMMENTS........................... .................... :.............-------.. ._........ .--..... ......_--.......... ......----........... - - _...-..... - ..................... ......... ----------------------------------- --------------------------------------------------------- ------------ -------------------- Final inspection by: - «c ? ........................... ........................------- -------. --......Date . ............... ........ SAN JOAQUIN LOCAL HEALTH DISTRICT W � E.H. 9 1-'68 Rev. 5M