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r FOR OFFICE USE: �. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No; _7 _-- _ ------ This Permit Expires 1 Year From Date 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 rylaide in compliance with Count Ordinance No. 549 and existing Rules and Regulations: '23'27 S C P FS POIAlT_ DR . JOB ADDRESS/LOCATION .------S-r_k r_3y�k_e-�_ s-`ca e _�:.pQ ._"�-�z CEDtSUS TRACT -------------- C Owner's Name -------- ,:-_ ----------- s� :Qs_— _t0,9R--- _� i 4one -------------- -------------------- AddressCit a ----------------------------------------------- Contractor's Name ----- 4 e''� o �� --------------License # _J _9S1 ---- Phone ---- -_023__149 Installation will serve: -Residence,Apartment House❑ Commercial : Trailer Court .❑ I Motel ❑ Other ----------------------------------- ------ ` Number of living units:-----l------ Number of bedrooms ____`_____Garbage Grinder l Lot Size ____________________________._____________- Water Supply: Public System and name --------- ______- r v�_k__________.4 s_-M e S__________________________Private ❑ Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ �- Y 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 sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK;X Size---------IS00____GoA------------- Liquid Depth Capacity Je_0_0_60�t Type ---- No. Compartments ---- --------------- Distance --.---Distance to nearest: Well A_.0_0 ______________________Foundation -- t#-D------------- Prop. Line ---t4__:----.___ LEACHING LINE [ J No. of Lines ------------------------ Length of each line----------------------------- Total Length -_________._______--_--_--- 'D' Box ------------ Type Filter Material --------------------Depth Filter Material ------------------------- ----------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --------- .............. SEEPAGE PIT [kj Depth -)................. Diameter 3_ t_ _ _ __ Number _______________.___-____ Rock Filled Yes ® No i0 11 r „ F i 1 ��- Q-e-U Water Table Depth ------------------------------------------------Rock Size -----1Y2-------------- 9d�A e r Distance to nearest: Well -------l__S�_Ctt3---------------------Foundation .-_1�_._________- Prop. Line ____ ............... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------.-------------) Septic Tank (Specify Requirements) --------------- - ------------------------------------------------------ •---------------•----------- Disposal Field (Specify Requirements) ------- S -----_ � _-- �� ---- = - --------- ` c,Un > - ---------------------------------------------------- --- ------------------------------------------------------------------ -------------------- -- --- ---------------'---------- --- ---------I----------------- ---------------- --------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify 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 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed _.._.___. ____.___ Owner BY n (_ Title -------' ----------------------- ---------- (lf other than owner) ;�VF EPARTMENT USE ONLY APPLICATION ACCEPTED BY __ � 'vJ DATE ---1' Zll 7 BUILDING PERMIT ISSUED --- -- --- - ---------- --------------------- --------------------------------------DATE ------------------------------------ -- ADDITIONAL COMMENTS ---------------- =--------------------------------------------------=-------- - ---- --- ------- --- - ----------- ------------------- - ------s --------------- = ` �'----------------- -- --------------------------------------- ` ------------------------------------ -- ----" - -----"------------------ ---2------7-"/ - f----------------------------------------------------------------------------- ------------------- - - --------------------------------------1---- ---r-- -- ----- = f Final Inspection=k�y� ` a: ` e °'/'` a Date _ _ . } J 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M