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FOR OFFICE USE: �- --- -----f--- APPLICATION FOR SANITATION PERMIT l a17 -------- (Comp �teinTriplicate} Permit-No. .7_/-___1f 7 • T --- ------ This Permit Expires 1 Year From Date Issued Date issued _.�O-_- Application is hereby made to the San Joaquin Local Health District for a permit to construct and in described. This application is made in-.;compliance with County,Ordinance 549 and,existing Rules and Regulations., _ --_ ,-.. stall the work herein JOS .ADDRESS/LOCATION ._; ,E f� `�i V ' Owner's Name CENSUS TRACT `x'7'1 - - ---------------= r Address --- --------- -�.f,% � ----------------- one ----- --= -- Phone ------ ----------------- ---------------------- cityy Contractor's Name •� �1--fn _ a : _ -------=------- ----------- installation Will.serve: y� Li.ense # r� / phone Residence [,Apartment Hou se:❑ Commercial:❑Trailer Court ;❑ ! k Motel❑Other- � .:, Number of living units:.-- -- ---------- ----------- --- i -- Number of bedrooms -_-_ r i .Garbage Grinder ..��1.C3_fLot Size -------/--- 1 ;C- Water Supply: Public System and name ---_--_- -_-_ Character of soil to a depth of 3 feet: Sand' ------- Private -------------------------------------- . --- P ' tem �. ❑ Silt❑ Clcry ❑ 'Peat❑ Sandy Loam Hardpan ❑ Gay Loam ❑ P Adobe Fill Material -_-__- --_- If es =f., Y type (P:[ot;plan.;�showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse i NEW iNStALLATiON: (No septic tank or seepage pit permitted if public sewer is available withi side.) PACKAGE TREATMENT [.] SEPTIC TANK.} ] n 200 feet,) Srze- Liquid Depth ------------------- pe} ------ Capacity Ty ----------- "= Material-- ------=--- -------- No. Compartments �D p Distance to nearest: Well ---- --.._->._.- ._ . t --„____Four ation --------- .CEAGHlNG LINE - - - - ----•---- � Prop.p• e ------•------------ No. of Lines_i -�� o Lin ---- ------------- Length of each fine--------d��. ' =--- Total -Length �f9 'D' Box ; �. t g e Filter Material o� ff -------------Depth Filter Material ---_------, -Q Distance`to nearest'Well -_-” d-•----_ Foundation '.Z 0 � SEEPAGE PIT ' . ------------------- Property Line _- _c�o V) Depth . Diameter . , ---- Number _,�__. Rock Filled Yes Water` Table Depth ----_--* -- gra N t p _ -� -------•----------------Rock Sire --- ---- -------'-------- Distance to•nearest: Well " -/aU / �� - _ _--Foundation __-_- -_ } REPAIR/ADDITION(Prev. Sanitation Permit# _- ,� • ' Prop. Line' ------ ;Septic Tank (SpecifyRe uirements - -------'Date -------------------- )} q ) ----------------- . , - ------- D B• Shc�Field (Specify Requirements) 'y C1 - - ---------------------•---- - -- . r----- ------------ -------------- ------------------------- s ----- ; s� - • ----- - �� it -_ ---------- ----------- .--- ---- - - . - --- S --- o a : ----------------------------------------- (Drawexisting required ahdit^o" -_- - -reverse side) ----------- I hereby certify that I have prepared this application and that - t County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local oHealth District; Home he,in accordance 'towner or Ih Son li Joaquin 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 an can- as to.become subject to Workman's Compensation laws of California." " .. p ;y Y person in such manner Signed .1 ---------- --- �w OwnerBy ` (if other than owner)-- -------- - ------------- Title ----------------------- -- FOR DEPARTMENT,USE ONLY BUILDING PERMIT ISSUED ------------------ F APPLICATION ACCEPTED BY-_-_-__ --- - ---- --------------- ------f------ f DATE ©- /y_ 7,1 DITlONAL COMMENTS ---LG-f y_---1--)-----------------Imo'alC = ---- .. - s ------------------------------ ------ �"00 7/ _ -- ------- ------=---- -=- - v Final Inspection b ---------------- - - --------- ---- --- ----------- ----------.Date ----- /d. -- - �� SAN JOAQUIN LOCAL HEALTH DISTRICT --- -----. - E. H. 9 1-'68 Rev. 5M