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P,A - 05-- 168 Suoo049&.2 I•OR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.7 9 _�7 (Complete in Triplicate) - Date Issued--/- — -7 This Permit Expires 1 Year From 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 Cou Ty Ordinance>. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-- --aS'r..-S----C-___-SYr l _____KIN....CENSUS TRACT_ .5 '[.�_._ _ -- -- 23103Owner's Name----�R.' _- . -- -- -- -- -------- -------- . .... --- ----Phoneg _ _. — ... r; Address Me,- -------------------------- City � '32--------- Contractor's 0- ----- p - - - -- Contractor's NamejP1A?'J tLe—_-___-.4::�'4>"_4 tZZ'T- A-4/ License #'ZOT--4--*r4-Phone-770-`1Z+ ------- Installation will serve: Residence X_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ------------ - ------------------ Number of living units:------- Number of bedrooms--Z---._Garbage Grinder-M43--lot Size.-A. ---------------- _.r- Water Supply: Public System and name ------- - ------ ----------------------------------- - --------------------- -Private Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan X Adobe ❑ ' Fill Material_ _If yes, type_----_------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r— NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 6- PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size-_- -.__ ----------- - - -->---- .-.. Liquid Depth. Ic y\3 Capacity - -------- -- -.. Type . -- - - Material ----------------- -- - No. Compartments ---- ---. - C MN Distance to nearest: Well .Foundation__. -._ __ ____ Prop. Line ---- - ------ --- LEACHING LINE pQ No. of Lines----------- Length of each line _ -------------Total Length_-_-__'7-h-------------------- .__ C/. 1 -t- D' Box -----Type Filter Material Filter�lylgteria4 --_►_ -:__--_- O / "I f Distance to nearest: Weil--------710____- Foundation-.— -----.__--_-.Property Line---ZP� :.: SEEPAGE PIT Depth_,Z-5------ Diameter _ --- ---Number...._.. - ------ Rock Filled Yes JK No XZ Water Table Depth --- ---------- --------=-!t-----_-:�_ -`Rock Size--- ------ I f j La- Distance to nearest: Well __�-Z�_-_.__-----.-_--- - _ _,Foundation-----�D.-----------Prop. Line---1[- _-__-_-_ REPAIR/ADDITION (Prev. Sanitation Permit# (r1Jl!- A ►[?h,---__ .ST �1ts�...--FE ---------- +) r L Septic Tank (Specify Requirements)---------- --------------------------------- =_ A / Disposal Field (Specify Requirements)--- -------4d-------.P9---LIFlkG_�---4-40. ------p�IJD--------4-------�0-----K�-�-----a------------ - - - _------- (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 Count Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District, Home owner or licensed agent_ signature certifies the following: "I certify that ' the performance of the work for which this permit is issued, I shall not famploy any person in such manner as to becom lect Work s Con laws of California." Signe ...- r u.t—• ----------.___Owne-r BY �R-hL-t�Atx- - N CKEYc }p ±CJ` --Title._-A4AJUA6.EYL... SAII/ `CC, PZEP7 (If other than owner) FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY- 00:- ------- ----- -----------------------•- �% ---- — / 7 ----------- DIVISIONOF LAND NUMBER.--------------------------------------------------- -------------------------------------------•---------.DATE-- ------ - -------------------------- ADDITIONAL COMMENTS- �Sc�--_:,... ------------------------------------1C ---•----�--- -------------------------- ---- ------------------------•------------------------------------------------------ ----------------------------------------- ----- --- -- --- - ----------------------_------_ --------•- -------•------------------------------------ Final Inspection by 1/.�' - ------- ----------- ----•- --------------- ---------- ------------ -------- Date --� = EH 13 24 SAN JO�kQUIN LOCAL HEALTH DISTRICT F&S 21677 REV. 7/76 3M W,.