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1 FOR OFFICE USE: XtlAPPLICATIONFOR SANITATION P&MITY -- -------------------- ------------------------------ (CompleteTriplicate) Permit No: -- Date Issued _. _=fig ~-� ----------------------- This Permit Expires ] 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 SS ------6AVAJ----AS_1Ud---------TiP/-ky----------CENSUS TRACT Owner's Name --------- L O- Al--------)'-I----v4_I 41/ - - U--------------------.----- -------------- - -- ----- --------Phone Address --------4J SS------- 41-Vat q Contractor's Name --____-- d/VFCity ----T� -Cy--------.- -------- ---------------------License # :----N-4------- Phone -----/r//�---.--..._ installation will serve: Residence (Apartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other -------------- ---------------------------- Number of living units:__.--- --- Number of bedrooms ______Garbage Grinder Lot Size ._ ------•---------__________ Water Supply: Public System and name -- --- ------ ------------------ ---------------- ------------- ----------------------------Private Charocter of soil to a depth of 3 f et:'-'Sand'❑ TSiIt❑" Clay ❑� `Peat 0 Sandy Coam � Clay Loam,❑ 41 e 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.) >' NEWPACINSTALLATION: ATION: (No septic tank or seepage pit permitted public se eis available within 200 feet,J f �� EATMENT Ca acrEPTIC 7 QK [ J Size_-- ___ .....X__-------------- ---- --/Q- ------ Liquid Depth ---#--- -------------- f P Y �a �1-- Type 4e(45 f_ Material-4L/ C_/_ T'No. Compartments ...a2_.............. Distance to nearest: Well .t50--�------_ _ ----.Foundation ----y0_1--------.Prop. Line ____ LEACHING CINE No. of Lines ] ___ ______ Length of each line__-_.__�� _____ Total Length __:__ t�a______,_.__ 'D' Sox ----/----- Type Filter Material _�>� '____Depth Filter Material _________/9'i________________________ Distance to nearest: Well ---- 470__....... Foundation ____ O_�______ Property Line _f_'�_/_0.1_____ ------- SEEPAGE PIT [ ] Depth _------ _------_--- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No C] Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ____________ _________________________Foundation -------------------- Prop. Line --------- ............ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -________-________________-_______} Septic Tank (Specify Requirements) -------------- --------------------------------------------------- ---- - - DisposalField (Specify Requirements) ----------------------------------------------------------- --------------------------------------------------------- ------ ----- --------------- -------------------------------------------------------------------------------------- -- --- -- -- -------------------------------- - ------------------------------------------------------ --------- --- - - -- --- ---------------------------------------------------------------------------------------------- {Draw existing and required ad - dition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin E 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: "1 certify that in the performance of the work for which this permit is issued, I shalt not employ any person in such manner as to become subject to.Workman's Compensation laws of California." Signed .- o�e-------------------------------------------------------- Owner 4 BY ----- - ---------- ------------- ------------------------- - ---------------------- - --- Title -------- - ---------- ----------------------------------------- (If other than owner) r FOR .DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY _-- -- --- --- ---- --- -- - �-----. DATE ----- ------��_----�� ------ BUILDING BUILDING PERMIT ISSUED DATE _ .� ADDITIONAL COMMENTS ------------ -----!/-INL S S �nIS. -- LL Q 5 ��'L-JT - - ------------------------- -------------- - ---- -- ------ ----P- - ----- ---- - - ------------------------------------------------------------------------------------- ------------- ------ --------- ------- ----------- --- ---- -------------------------------------------------------- --- -- -- - 2 _ Final Inspec i - -- ---- ---------------- -- ------------------Date --- ----- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT .4 4 -j E. H. 9 1-'68 Rev. 5M