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FOR OFFICE USE: APPLICATIONJOR ANITATION PERMIT ------------- ----- (Complete in Triplicate) Permit No: ---.---_-.-_-- • ` 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 mad_a in compliance with County Ordinance No. 549 and existing Rules and Regulations: I JOB-ADDRESS/LOCATION"' - - - - -- -CENSUS TRACT �--•"""'�'--°'-.---_-- Owner's Name ..-_ Anna Bellone t� ..--. ----------------------------------------------------------- Address -'"S ]lte - - � _ �Ci y one ------._.�-- -------------------- t �..�,�1�n---------------------- 2'68 1 463.- 048 _____ [ Contractor's Name --B--1-acka-r-d*�---S�p�G�:d---T-a,3'kk--GE��------- -------License # --=- ----:-9-�r-------._ Ph;one -------- -7---•-•--- Installation will serve: Res idence.[].Apartment_House❑.,Commercial :®Trailer Court i❑ • � t t LMotel ❑Other Numberr;of living units:___--2----- Number of bedrooms -- ----.---Garbage Grinder ------------ Lot Size -ZQ4 tX100--- I # Water Supply: Public System and name - --- City _.___ _ ______ _ ________private ❑ --- ----- ------ Character of soil to a depth of 3 feet: Sand'[] r Silt',❑ Clay'! 'Peat E] Sandy Loam ❑ Clay Loam ❑ r r I e # Hardpan.[] Adobe f3d Fill Material __- ----- If yes}type ---------------------------- (Plot _-__----_'__----___--_--(Plot plan, showing size of lot, location of system in relation to wells, buildings, efc.i must be placed on reverse side.) 4 ; NEW INSTALLATION: 1 r ` - (No septictank or seepage pit permitted if public•"sewer is available within 200 feet,[ N t s r •. Ci uid PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size------_-- ------------------'- '------_-==_;a-- _ q Depth . Capacity --------- — Typed w f` V. -- Material-- --------------- Compartments ---------------------- Distance to nearest: Well 4i_---------------------------------Foundation ---- ----------------- Prop. Line __-_-_---- --:-_--_--- LEACHIG LINEI F` } �] No, of Lines -.___1---_-__-__-_Ir_ Length of each line-lD-'_--.--"---- ------ Total Length ld-g-------------------- D' Box ---1------ Type Filter_Mlate,rial -11---------------Depth Filter,Materia! ---1_9"- �. tf 1 Distance to nearest: Well �_n-- ---------- Foundation -----1Q 1-i__-__----_ Property Line --------5,'_- t i v r:.-.....--`.-.,»...r+-rr- -..+....-rr'--._ ..`+..w.•A--^�-wry_._ .,�a`.v.--•`»--.w-.•v-ate ,w.,y,-��w -_-_-_•_•- SEEPAGE PIT } ] Depth 2 -------------- Diameter _----�1$'�-_-_Number -------- ---------- Rock Filled Yes [�J No .i❑ Water Table Depth --------------9aRock Size 2�� Distanceto nearest: Well .------ --- -- Foundation 30 -- Pro Line ��-..________.__.. . REPAIR/ADDITION(Prev. SanitatiYon Permit e# __--_ _- 4- 8/24•/6 ) --------------------------- Date ---------------...---------------- Septic Tank (Specify Requiremenfs) -------------------------- t` 14 -----------------------"_----_--_._-----__-_-_--- ___----•____-_-_- __-__-----k-_-.._------------------------------- Disposal Field (Specify Requirements) Leigh-.bine_ & Pi- $=' 5-- - i --------------------- -----------------------------1-- ------------------- (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 0cen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman'sliCompensation laws of California." Signed f, j ---------- Owner ,s ---------- Q ot er than owner) , -------- ----------------------------------------- R D RTMENT USE ONLY APPLICATION ACCEPTED BY------- --- - -- / ----- - -- - -- - -- ---------. DATE l = BUILDING PERMIT ISSUED ------ ------- --------------- TE ADDITIO L COMMENTS ---- -- ----------------- /-/-77V-- �� --- -- - - ------------ -- al - - - Fina Inspection by: Date ,l - ,�.e,� SAN JOAQ N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M