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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _79:7_4 ---------------------------- ----------------- ------- (Complete in Triplicate) -------------------------------------------------------- r This Permit Expires 1 Year From bate Issued 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 xisting Rules and Regulations: 1 �j f- - ---------------CENS/ TRACT -------------- - ------ JOB . -------- Owners Name , JOB ADDRESS LOC �7 _ N L �j ------- --------Phone -- �l T ° f�! � City �J � Address o�- -- d ------------- ------------------------------•-•---- w Contractor's Name 1-- 4 �Y - __-_ E- Phone - ------1j• h'�-. _Ll--+S ----- U? tZ !` License # � _ Installation will serve: Residence Apartment House❑ Commercial ❑Traileir Court i❑ 11 Motel [:1 Other ---------1------------------------------- Number of living units:------!__-_ Number of bedrooms ------ -___-Garbage Grinder ------------ Lot Size -__! _ -r--- ---r--`---- ------- --------------- ------ E Water Supply: Public System and name --------------------- --------------------------------------------------- Private Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam •❑ Clay Loam. 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.) NEW INSTALLATION:, (No septic tank or seepage pit permitted if public sew r is available within 200 feet,) ..... .-, is -T PACKAGE TREATMENT [ ] SEPTIC TANK ze - _ ___- Liquid Depth ___________.___________- Ca acit � Materiai No. Compartments -----------------_-- Capacity P Y �` Type P ------•-----J-_-- �Q- ---------------Foundation __/_0------------ Prop. Line ____5------to nearest: Well ___-__ � j, LEACHING LINE No. of Lines _-I --------------_ Length o each line---- -- Total Length .-- ®-�•.-• -------' �i , fat �1 _De th Filter Material �_ ___`�__---- -- -----•- D' Box ______ __ Type Filter Material ___ _______ p -�P�o{" ' i TT Distance to nearest: Well _ --------:__ Found anion-�-� ==>-------- Petty ane, # x i ___.- ______-_ Rock-Filled' Yes ❑ No SEEPAGE PIT [ ] Depth - ----------- -------= Diameter ---------------- Number ----------- e Water Table Dep th -----------------------7!-'-'-�-4-77--1----Rock Size ---- i Distance to nearest: Well .- `°:"_r_�- •-- ----Foundation - ----------------- Prop Line ------ -------- f REPAIR/ADDITION(Prev. Sanitatic, Permit# ----- ----------- R- Date -------- r Septic Tank [Specify Requirements] --- ------- „-F -- -- # - ---- - - ------ ---- ' ------------------------- Disposal Feld {Specify Requirements) ___ ----------�--- -------- - - t . ----------------------------------------------- --- l F -- . ------------ ---------- (Draw existing and required addition on reverse side) I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin fY County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- 7 , sed agents nature certifies the following: "I certify at the perform"c of the work for w ch this pe mit is issued, I shall not employ any person in such manner as to bec me bject to or ma 's Co Pensation aws of Ca fornia." j Signed _ [ By ------------- -------------------------------------------------- ---- - --------- -- - --- Title -- -------- --- -- -`---- ------------------------ (If other than owner) FOR DEPARTMENT USE NLY_ I APPLICATION ACCEPTED BY -------------_------------- - ---- ----- ----- ....... - ----- DATE = c1 -------------- BUILDING PERMIT ISSUED -------------------------------------------------- --- -------DATE -------------•----------------------------- ADDITIONAL COMMENTS ------------------------- ------------ --------- -------- --------------------------- ---------------- ------------------ --------------------------------------------------- -- --- ---------------------------------------------------------------------------------------- ------------------------------- iTRICT Date _.-�.-1?.- Final Inspection b SAN JOAQUIN LOCAL HEALTH E. H. 9 1-'b8 Rev. 5M