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FOR OFFICE USE: " y u -�PLICATION FOR SANITATION PERMIT 4 Permit No:.7� :: 35.E •• �- \ (Complete in Triplicate) Date Issued .7!� This Permit Expires I Year From Date Issued ------------- Application is hereby ma4e 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: ' ii 16- •' O1Zy p;�.ye--------------- CENSUS TRACT _-._.. _ .._ JOB ADDRESS/LOCATION __- $ .• OZ ...�-._. onnie -- -e • •--............::..._.....-----------Phone-------3�.. ..._.. BY Owner's Name .............................. Se .. Address ...... City �r .... _ .-- ---._--------.................. M:^..:` '•_--•-------._. _..._.-•_______..._......._._. r ..L ._. y... 4 Contractor's Name ....)43 133°5��.._PZ77TIIb� t3g._ ��'et-DD :....•...License # ---99.594------- Phone Installation will serve: Residence X] Apartment House ❑ Commercial 70Trailer Court 0 Motet ❑ Other .- �pr• XTZ' q. Number of living units:._:1� �-I ___ Number of bedrooms .___ •�>arbage Grinder ------------ Lot Size ... ................... Private (. Water Supply: Public System and name -------------••---------------------•-------•- •---- '' Peat Sandy Loam ❑ Clay Loam Character of soil to a depth of 3 feet: Sand E3 Silt ❑ Clay ❑ ❑ I' Hardpan ❑ Adobe -E] Fill Material ............ If yes, type ----------------•----------- r (Plot plan, showing sizeof Iot�Location of system in relation to wells,ybuildings, etc. must.. be. placed on J 'f ublic sewer is available within 200 feet,) reverse side.) NEW INSTALLATION: •`'(No -septic tank or seepage pft permute p ..! - fm- Li uld Depth -------------- PACKAGE ---- ---•-- PACKAGE TREATMENT .[P.� SEPTIC TANK,[ ] "� -,.•: ------------ q p 'r Material-�•---- •------- No.• Compartments ----------• � ._.... pacity-------- ------ -ype;r �--- Dto nearest: Well ...............!f ................... -- - - - - -•-:-- Prop. line ............. D Total Length t �ir.nfoe Lines.......... Length,of each line -------------- ----- g ••....._. LEACHING LINE: [ ] Box ._-_....-_._ Type Filter Material:........ -4 --.••--•-Depth Filter Materials-_---•....._..---- '0' _ _ _ ..... �!F y �'`, Prope`rty'Lme� I3istance to nearest: Well _____________________•-- Foundation ;--;-•-- r No 0 SEEPAGE PIT (] Depth Diameter ---------------- Number Rock Filled Yes ❑ ] Water Table Depth 11 --.......Rock Sizes.--......_..-----••••-- ------ ---------•4--••••---Foundation ----- --I--• Prop. Line -•---•--- .....---• a Distance to nearest: Well ___________________ I REPAIR/ADDITION (Prev. Sanitation Permit # ------------------------•.------•.--- L ----:-Date _nn .......... "-------------- 1 ,- Septic Tank (Specify Riquirements) .......... .......... -----••-- ----- ••------•- ._...,....__....- ,I ZQO - Z�n _ ...• 1 W . , ��-��Pa11$im1 Disposal Field (Specify Requirements) ............. .•.--- ------��-'----- idB-_-1Qr� 9b . Ag...O!Aa 2.. .:.. ................. •--- ... = --- ----- -- S--•----•---......- j '` (Draw existing and required addition on reverse side) I hereby certify that I hailve 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 San Joaquin Local Health District. Home owner or County agents signature certifies the following: P erson in such manner ..I -'certify that in -the--perfbrma o t work for which' this ermif is issued, 1 shall' not employ any p i t as to become subject to Worl an's Co ens n of Iifor ia." Signed p UIST'' Pr�...._.I�ITG = ' ------ . --•- . By --------------------------------------------- itle .--•--��Aag_l_ - (if other than own FOR DEP Ait ENT USE .ONLY APPLICATION ACCEPTED BY_ ------------------_-- -------==----------------- - - ...... ,�.� i7,... DATE ...__6-7u-•-................ BUILDING PERMIT ISSUED ...._-_-_-----•-_-------•-----•- _._--------- -------DATE ADDITIONALCOMMENTS--•-•-••--_-•--..._...----•--•----=-----------------•-•-••---._......---................----•-......•••. •---.--•-- 11 1 --------------------------- .................... .................... ....._--.._..........•..... ........................ =-•----• .... ..............•---•-----•--- ic 4�1 a l - .....--- •-•---.:-=-- ....................•--•-... - ..Date .... __..._ ------ Final Inspection by I --••-- -----------------•-•----- SAN JOAQUIN LOCAL HEALTH Dl RICT E. H. 9 1-'68 Rev. 5M