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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- ------ le Permit No. (Complete in Triplicate) --------------------------------=t_f i�------ ------- This Permit Expires 1 Year From Date Issued Date Issued _3 , Application is'Fier-eh miide,to the San Joaquin Local Health District for a pp y q permit to construct and install the work herein F described. This application'is`m.ade in compliance with County Ordinance No. 549 and existing Rules and Regulations: jt JOB ADDRESS/kbCATIONj-- -' ---- -LQ--------} - -f---------------------CENSUS TRACT -------------------------- 6 7 "'� ---- Owner's Name! -----------EpVV6-------------v_=�! ��5---------------------------------------------------------------------Phone Address Contractor fS Norrie ----OW.At f-------------------------------------------------- --:-------License,# -- -- _ Phone _ Installation will.serve Residence,❑Apartment Hbuse�❑ Co ercial :❑Trailer Court ;E] Motel, Number of living units:___ _____ Number of bedrooms ______Garbage GHnder1,F-5 Lot Size _/ / �___________- I._ Water Supply: Public System and name -------------------------------- w ' Private Character of.soil to a depth of 3 feet: Sand❑ Silt Clay ❑ Peau❑ Sandy Loam i J Clay Loam:❑. . -Hardpan-E] -❑ Fill Material,_ __.____ es,type__ ______-------------- � i w;�r, � _ � -. ; sera i ,v. (Plot plan, showing size of lot, location of system in relation to ells, building's, etc./mus-t-be_placed Ion reverse side.) V NEW INSTALLATION: (No septic(tank-oir'teep pit permitted if public sewer is available within 4200 feet,) �� 0 { ]�•SEPTIC TANK - 5ize_______ PACKAGE TREATMENT"- [ ; -� �Q x i� Liquid Depth,_ (,moi Capacity 15VQ____ Type AIKO------ erialCOAKKT No. Compartments o.:.......::... tom. � - � r � t. .. I Distance to nearest: Well __ - ---____________Foundation s)__/ ___^t"__ Prop. Line __.�____"`- ____ E LEACHING LINE [ No. of Lines ----- __--.--__.___ Total Len th _ ____ _______ �' __.a 1 __ _____________ _Length of•.,each Iine______.S� t g _ � 'D' Box�X�E_S_ Type Filter Material' V_C, __Depth Filter Material _ ___ __ _ --r -- [ Distance to nearest: 1Nell -----6-6--ft= Foundation 1_--- Property Line ___ ..........:.... ar i SEEPAGE PET [/� Depth /-,'7 _{__ Diameter�_X__ Number _._____ _- Rock Fil ed Yes No ❑ 1 r �-f r-=�M( Water Table Depth _- ( ____________""__--..Rock Size t Distance to nearest: Well _._14949_______________________Foundation -1Q _ p. Line .. ._..._........ REPAIR/ADDITION(Prev. Sanitation Permit L Date J 4N Septic Tank (Specify Requirements) --------------------------------------------------- --------------------------------------- ----- Disp Field {Specify Requirements) ___________ osal ----------------- •--------------------------------- -------------------------� { ------------------ -------------------------------------------------------- --- --------------------------"------------------------------- --------- ----- - ----- t " z i (Draw existing and required addition on reverse side) ' I hereby,,ceirtify 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 signature certifies the following: "I certif t in the performaVcef the work for which this permit is issued, I shall not employ any person in such manner as to "� subject to ork Compensation laws of California." Signd1 _ ------- - -------`----------------------------------------- Owner _ BY ¢ 1 ----------------------------------------------17,.R__0----- Title --- ------------------------------------------- ---- -s' (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------t7iR4-Qr------------------------------- DATE BUILDING PERMIT ISSUED --- ---DATE -------- ------ ADDlTIOIVAI comWENTS- ------ - - -------------- - -- -- -------------------------------------------- ------------------------ - - - - --- -- ----- - ra - - -- t, '�----------------- --------------------------------------------------- -------------------------------_ -- ----- -,�— � - - ---- - - ---- --.- _ . __ _ T _ p Final Ins - ---------------- --------------------------------------Date -- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M