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FOR OFFICE i1SE " APPLICATION FOR 'ANITATION PERMIT � --------------------- ------- (Camp 't , '+Triplicate) Permit No. _.__7�_-0s7 ---------- ------ �` . Date Issued. ---------------------------_.------------------------- 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: { JOB ADDRESS/LOCATION _._�V_r__q_.___- - ---JAC-KT©ry E-------PD k - ---- i - f - -- CENSUS TRACT . `5 .. fiRT_ _)4U_R-------�IOwner's Name ----�- EETE_13_R- --- - - ---- --- --- •---Phone ----------•---------------•-••------ � ` Address ------------2 ? (c. .---------^� City P Contractor's Name -------QLW4,EPI-------------------------- -------------------- -------License # --------- ------ Phone --------------------- Installation will serve: Residence partment House❑ Commercial ❑Trailer Court ;❑ Mofelf❑Other -------------- ---------------- Number of living units:________ Number of bedrooms __ _____Garbage Grinder _JV0-__ Lot Size __ - _ _ --------------- I Water Supply: Public System and name-_.' ------------------- - ----------------Private E , Character of soil to a depth of 3 feet: Sand-'D Silt❑ Clay ❑ -Peat❑ Sandy LoamClay Loam ❑ Hardpan ❑ Adobe ❑ FiII M' terial� _`If yes;typeY____________ _ ` f ------ (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 it permitted if public sewer is avail le within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK:[ ] Size---- -------------- --------------------- ------ Liquid Defih --------------------:----- Capacity_ I-----------_ TYp ----- ------ -- Material--------------------- 6:3 ompartments. ----------------- --. i r''� Distance to nearest: Well ------------------------------------Fundation __._: ___ _ _ _ Prop. Line ____-----------_____.. W LEACHING LINE [ ] No. of Lines --------------------- -- Length of each line----------_---------.-- -- Total length ------ i # 'D' Box ---�____.__ Type FilterMaterial __ _ Filter M terial -------------------- Distance to nearest: Well _ ---------------- ---- Foundation -_---_ _____ Property Line. ---------.______-_. _. SEEPAGE PIT [ ] Depth ____---- ---------- Diam ter _____________, Number ----------------I! -- _____ Rock Filled Yes ❑ No Water Table Depth ------- -- ------------------=---------- -----Rock Size ---------------- l � f = 11. Distance to nearest: Well )---------------------------------------- -----`=�=--Foundation I - - --------•---- Prop Line -•-------------------- REPAIFtfADDIT[ON(Prev. Sanitation'Permit # ---__---------------------- ---------------- Septic _-�- ----- =-- _=-+=- Dated` ) � � _ --- Septic Tank (Specify Requirements) ----:p(5T`__BfJ�------------90------- ---- t �� a I Disposal Field (Specify Requirements) ---T0-------F-AI-STI-1,:06--------` J /Y? -- ----- I----------------•--------------- --------------------------------------------------------------� :--------------------------------------- --- .1 i------------------'--------------------- ----- ---------- �'' --- ._ F ;,• - f (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 San Joaquin local Health District. Home owner or licen- sed agents sign ur ertifies the following: "1 certify that i th perFor n o t e w k for-which this permit is issued; i shall not employ any person in such manner as to beco s -to Wo an's mp sation laws of Calif prnic.';' : 5 By - -- -- - --------------- ---- r---� ` _��' ,.TOi , Signed i -wner (J (If other than owner] —`y FOR 6661'*TMENT-`LFSE ONLY I APPLICATION ACCEPTED BY ----- f _ -------------------------------------------------------- ---------------- DATE ------ - ` �. --------- * . BLIIL- PERMIT-�PERM�IT-- 7 - -_-.-•----•--• _. .�__,,_ .�..�—_—__ _ - DAT ---• ADDITIONAL COMMENTS -ri - ., f { {,� !' _' t--- --------- - ---- ------ - - ------------------- -----------------------------=--=---------------- --------------------------- ------------------------------------- -- Final Inspection - - ------------ -- - ------ - - -------------------------------- ---------- Date ---- '1ta SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev, 5M t