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F �r 3c FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --3- - - ----� ..:��_�-- ~- ----- -- --- Permit No. 7.L.--3.3 � (Complete in Triplicate) --------------- ----------- /-��' 3 Zzf 7Z Date Issued -------------------- _ This Permit Expires 1 Year From Date Issued r 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. 5.49 and existing Rules and Regulations: JOB ADDRESS/LOCATION -------155 - - a-�---`c----------------------------------------------------CENSUS TRACT ---------------•- -------- ------ -- ------- Owner's Name ------------ --------------------------------------------------------------- -----Phone ------------------------------------ - s- --- �------------ Address - ----- .----- -er- w � CitYS-- - -------------- - �u-tin-inch- ------------- .-------.License #1-0-71f ------ Phone --------- Contractor's Name --------jo-kk-S-F------- Installation will serve: Residence T�Apartment House-E] Commercial :❑Trailer Court i❑ Motel ❑Other -------------------------------------------- � / Number of living units:------/--- Number of,bedrooms ---�--.Garbage Grinder -��--- Lot 5ize ---- ?G_�L_�1(o:_le----------------- Water Supply: Public System and name --------- --a-ftl-------- --------------------------------=-- ------•- --------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt O Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ G Hardpan E] Adobe (EY Fill Material --.---.-___ If yes, types:'' --------i-------------- . R (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,) I I I t .� PACKAGE TREATMENT [ ] SEPTIC TANK�K Size-----------/o2D_I?----_ 4--1-------- Liquid Dept -- _----- �n1 --------- capacity,-; Type p y _.�_� s T e -- zle —Material-----C.P-jnC-"__-: No. Compartments �-----------=---- Distance to nearest: Well ---------------------------Foundation j:_----4 -__-_- Prop. Line ----------------.---.- LEACHING LINE [ ] No. of Lines -----/-____----- -- Lgngth of each line......1--U__.'--- - ---- Total Length ---L�--`---.------- 6y, _i--- Type Filter MatericOTXv_14--Depth Filter Materidl - -__-/ - 'D' Box - -----• -��-----------•--- E Distance to ngarest: Y� ell ----N��-------- Foundation ---J'p---�-------- Property Line _-`-------------------- 2 l� r!r ��--`- Number SEEPAGE PIT [ ] Depth - - - ------ ----- Diameter _-_ - _- --------------- Rock Filled Yes No ❑ r `{ ' - Water Table Depth -------------------- =---------------- -------Rock Size Distance to nearest:Well ---------.-�_�-----------------------Fouiiclation- ----------------i--- Prop. Line --------_----_.----_.- q REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------s----------- Date ------------------------------- q -----------------------------' , Septic Tank (Specify Requirements) --------------- i---------------------------'-------------------------------------••------------ -------- -- .. ----------------------- Disposal Field (Specify Requirements). `=' s--------------------------- --------------------------------------------------- -------- ------------------ --------------- -------------------------------------------------- ------ ------------- -------------------- —-- -= ------ ----- - ------- -----------€-------------------------------------------- ------------------------------------------------- ---------------------------------- (Draw existing and required addition on reverse side) + 1 hereby certify that I have prepared this application and that the work will be done in accordant a with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.District: �ome 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 become subject to Workman's Compensation laws of California." Signed ----------- -T-'--!�------wGtle. d --------------------------------- - Owner ----------------------------- 1 BY --------------- ----- CD - /- ------------------------------ -Title'' (If other than owner) FOR DEPARTMENT(USE ONLY i APPLICATION ACCEPTED BY ----C--- -------------------- --------------------- - -----------. DATE --- — -------- BUILDING PERMIT ISSUED ------------------------------- - -- ----------------------------------------------------- -----------------DATE ADDITIONAL COMMENTS ------------------------ ---- � � ----------------------------------- �-f---- -------- / ----------------------------- --------------------------------------------------- ------- ------- �--- - ------- --- ---------------------- --------- ----------------------------- - - - - - ------ ----- ---------- - ------------------ ------ Final Inspection b ---------Date ---- - -� 7.Z-- - - - ---------------------------------------------- - ---- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M