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FOR OFFICE USE: Y r y �APPLICMION_FOR SANITATION PERMIT ----------------------------------------------------- �. (Complete in Triplicate) Permit No. -. --------------------------------------------------------- This d I t D F 1 Y i Permit Expires Year From Date Issued 1Date Issued t�5-A SZ7 --------------------------------------------------------- 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 1made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-t-lf-F�lJ-7BQ59iRa?_---pt3-cK1----------------------------- ---------------CENSUS TRACT -------------- ----------- Owner's Name ....Q_v i--- F--- 1' xW_a J ----------------------------------�----=- -------------------Phone -------------------•---------------- _- T; 0)L r GLdoo---•--- City --- ------------------------------------------------- Address C L- --- mn + Contractor's Name - --A-,--��Rlu- -? -- --- 5---------------------------License # -2-57-4-30-- Phone 4-6-67-960-7---- Installation will serve: Residence ❑ Apartment House-E] Commercial :[]Trailer Court ❑ MotelOther __G tpLF__Cb_oz �-C_L of 4tdse �] Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size -E'-`_c'Rc�-------------------- Water Supply: Public System and name -- u e12l�1 __ A' •-_3- �I------- — ------------------------•------Private El Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) \ PACKAGE TREATMENT [ SEPTIC TANK [ Size- sr^N-�31A4aX-5'9°` -- Liquid Depth - 4Ii-------------- Capacity 4-6.0-0------_--_ Type P915eOVST_ MaterialNo. Compartments _-Z------------- CAt -- Distance CC-IJ _ Distance to nearest: Well --- 1A--------_---------------Foundation ---(0--_-----__-_- Prop. Line --_-___-_- CC—IJ e � LEACHING LINE } No. of Lines ---_8---------------- Length of each line-J00 --------------- Total Length _890__--------.._.__ yo, 'D' Box __Z------ Type Filter Material t -_-_Depth Filter Material -__ ._ __________________________ Distance to nearest: Well - 141A Foundation --')P---------------- Property Line %Fr-t!;? SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number .-------.---------------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -•-------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) -------- ------------------------------------------------------------------------------------------------------..--------------------------- Disposal Field (Specify Requirements) - ' --,ar ---- - `------- V., ------ ------ -- ---- t� T r `-------------------------y---- G -----------------"�- -------G'"'-------�-- " (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 Son 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 performance of the k for which this permit is issued, I shall not employ any person in such manner as to beco ' c�,t Workm 's Ca p nsati.o$ la of California." Signed ----- -- ' Owner �r3 _____ BY �'----.-QMtQ.-l�ti-� � ------ ''- ----------- -------------------------------- - Title ------ -f�.�5tD�3-� ---------------------------- - - (If other than owner) de OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------- ----------------------------------------- DATE ------- BUILDINGPERMIT ISS -------------------- -- ----------------------•----- - ----------------------------D TE ------------------------------------------- ADDITIONAL COMMENTS ---- ---------------- ------ -------------- ------------------ -------- _ --------- -- ----- ---------- ---- - -- -------------- ---------- �' ' � ---------- --- `�---- - --------------------- --------- ----------- ---- ---- Final In ction by -- Date N J JAQ.UIIv LOCA_ _ L HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M