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f; FOi2 OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------- -------------- Permit No �IW___/DO/ (Complete in Triplicate) 41 -_-- This Permit Expires I Year From Date Issued Date Issued _/�-3'_ __-- Application is hereby made to the San Joaquin Local Health District for a per 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 .--_- Z -ry`2--- ------ f------[�_l_PQ±�l......-------------- � ,--CENSUS TRACT `-� � -'----- � R ' Owner's Name .--------F ns -----------145---i�-�_�_R,�-1---------------- =- `=; Phone 1 lQ Nr City `''-:'` r Address ------------ / ------- ,. Contractor's Name -----r?_VVW R`- -- -- --------- -----------------------------------.License # ---------.-------�--��Phone ------------------------------ Installation ---•---- -- -- Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court ',❑ Contractor Address License No. Phone__ v'v ------ - Water Supply: Public 5y stern-arid name t Private El Character of soil to a depth of 31feet: Sand'[:] Silt❑ Clay .❑ Peat ❑ Sandy Loam Clay Lo I0 _71 Hardpan ❑ Adobe ❑ Fill'Material 10-- 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 feet1.;)1 O PACKAGE TREATMENT SEPTIC TANK'[ ] Size------------------------------------._._-- - >- Liquid Depth =: ________.---_.________ 4.`- r Capacity ----- -------------- Type --------------------r Material-----------� 7-- No. `Compartments , ----:.... '� Distance to nearest: Well ___________________________________Founrdation F.______-----_- ._-_ Prop. Line''_-_..;______________ LEACHING`LINE _j;] No. of Lines F4- ___________ Length of each line------------------ -------- Total 'Length ------ _.,__-.._..___.___. o F1�T 'D' Box ------------ Type Filter Material ----- --------------Depth Filter Material _.__ ------------------ -----------_...... Distance to nearest: Well ------------------------ Foundation ________________________ Property _____-_-__. SEEPAGE PIT [ ) DeptWateh Table De th Diameter _______ 3____--4N&Mbe O` Rock Fille Yes ❑ No ❑ p ---------------------------- - Rock Size � `�-..a'-- --- Distance to nearest: Well -------------------- -_F i---------------- oundation ----------- ? ------ Prop. Line ----- .............. I / REPAIR/ADDITION(Prev. Sanitation Permit# -------_-------------------� Datet_______,_ ------------i) Septic Tank (Specify Requirements) ------ -------------------------------- ------------------------------------- i----------------- ---------- ---------------------------- Disposal Field (Specify Requirements) -------- __----- i n -------- P-_,IF ---F'P-6--------------- -----_----------.c �V/VFc-�- ------- X- ' = N 1-1�1f �.------�`" ------- V - (Draw�exi ting and re�uire'd addition on reverse side) - 1-f-E 04 I hereby certify that I have prepared this I application and At the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules aid Regulations of-thi:San 16aquin`Local-1Health District. Home owner or licen- 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 bec sub' t to WorkmiaW4 Comens ton laws of California." Signed ------ "> -� Xt- --------------i-------=----------------------- Owner BY ------- ------------------------------ Title -------------------- --------------------------------------------------- (If other than owner) I FOR D0—ARTMENY USE ONLY. . i •�, � ;11 ;`1 APPLICATION ACCEPTED BY .---. - --------� -----------�Cj------- _a--J--J-------------�'�-----:-�---'D'A'- TE----- �r------- BUILUING` ----- — -- ---------------------- -- ADDITIONAL COMMENTS - ------- --------------- - ------------------------- -------=_.. ------------ - ---- --------------------------------- ----------------------------- --- - ; --------------------- ---------- --lT--- ----- ------------------ -- ----t -------- ----- -----------------------------------------------------._-------------------------------------------------- --------------- -=---- - - ---- -- -- ----------------------------- f 1 Final InspeE#fe� -----.Date ------ I_L-- - F yV SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M