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rvx vrri�t UJt: r� >� ,kG J Permit No. (Complete in T - . ` APPLICATION FOR SANITATION PERMIT o L Triplicate) - - Date Issued l 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 County Ordinance No. 549 and existing Rules and Regulations: LCENSUS TRACT JOB ADDRESS/LOCATION _...I7../.i�LL----SO.r-----1t.ICT_0 ------ -��- ------------------ F------• Owner's Name :5 1S1.L7. - - -. ..... Phone ----------- --------- ----..... p - L Address ----N-�21-- ---- S ` ......V tCT l h�' - City Contractor's Name ----D WNER ------ ---- ----- --..License # --- ----------------- Phone - - ------------------ Installation will serve: Residence Apartment House F1 Commercial'❑Trailer Court ;❑ Motel ❑ Other ---- --.._ Number of living units:------I-_- Number of bedrooms ._3..___Garbage Grinder>(C-S_ Lot Size 19CREAG _._--.-.- - .- Water Supply: Public System and name ---------_- ----------- -Private r Character of soil to a depth of 3 feet: Sand'❑ Sil ❑ Clay E] Peat❑ Sandy Loam ❑ , Clay,Loam Hardpan Adobe ❑ Fill Material (Plot f�pe .t f) --�Qf1Nf - (Plot plan, showing size of lot, location of system in relation to//wells, buildings, etc. must be placed on reverse side.) P P P T q Pet) NEW INSTALLATION: (No septic tank or see a it permitted if public sewer is available within 200 feet,) // it / -_ Liquid De t� . Sip.------------- Compartments � PACKAGE TREATMENT [ ] SEPTICy�TANK� Size- --LQ. X icc . _.v.. _. _...-.. 1J Q Type E S I-fv)aterialCt2/1[CI� 1.F.�lo. Compartments .._�,,,.---__ - Capacity - - ---- yP 4 _ . stance to nearest: Well ----- . ._ "l-_.---------Foundation --.f�.-' ..- Prop. Line'.- -_____ ? LEACHING LINE [vJ No. of Lines ----- ....... Length of each line 9 r Len -( - Total Length __ � O C 'D' Box�.�:5 Type Filter Materkal )ROCJ!5�----Depth Filter Material I ----------------------------,---- ••- ' Distance to clearest: Well ---14949- .--.-f Foundation �p--fi .- Property Line --Jr...^ ...... SEEPAGE PIT [/� Depth - r...... Diameter- --X -- Number 'L . . .. Rock Filled - Yes ET ❑ Water Table Depth ---:30---- --- ---------- ------Rock Size .-I-Z-•,-..---�Z�s.�-y Distance to nearest: Well -/�d_--..-_-----_------ ......Foundation �D.�.--._....-- Prop. Line ___5- ---- f REPAIR/ADDITION(Prev. Sanitation Permit# ........................._-- -..----- Date -.----_-------_------------_---) LSeptic Tank (Specify Requirements) ---------------- .................... --------------------------------------------------------- +-------- ------- \ Disposal Field (Specify Requirements) ..................... ............... .....- ..... --------------------------------- ...............I- ----- ---------------- - ---------•-...a --.-_----------------------------------------------------------------------------------------'---------- - --------------------------------------------------- --- ---• -- -- ` L -- = - - - - - - -------------------- \ (Draw existing and required addition ott geverse side) I hereby certify that 1 have prepared this application and that the works 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 following: "I certify that in the performa e f t work for which this permit is issued, I shall not employ any person in such manner as to beco blect to Work a s m n laws of California." Signed -- --------- ..... ----------- Owner By ------------- - ------- ------------------------ - - fire - Title -- .... ----------------------- (If other than owner) ` D FOR DEPARTMENT USE ONLY Ir APPLICATION ACCEPTED BY `rl e - - - DATE ..... . -'..ZO... BUILDING PERMIT ISSUED ------------------------------------------------------ --'-------------------------------------------.-. DATE ADDITIONAL COMMENTS ------ - - - ----------------------------------------------------------------------------------- -- -- - = Final Inspe ion by: 0 -U - - - Date -I - SAN JOAQUIN LOCAL HEALTH DISTRICT LE. H. 9 1-'68 Rev. 5M