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h�. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No,7 -Q- (Complete in Triplicate) Date Issued ------- _------------------------------------------------ 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 .1 described. This application ismadein compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADbRESS/LOCATION 1 ----DAN,/1�� l��O ---------- ------ ------- - -..CENSUS TRACT ----------------- -------- Owner's Name __Phone �o_" LE�-7--1-------- Loy -o ,�l� h�Qps - - - City - ��S�TQ I -------------------------------------------- Address - ��-7----E--.-C}�14_�-�`-�'L--- --------°-------------------------- -- • Contractor's Name --------0_W__t4-1E_ --- - License # ------- - ------ Phone ------------------------------ Installation will serve: Residence E] Apartment House Commercial :❑Trailer Court ',E] Motel ❑ Other .-M-ooss-_-Uo Hca �,LD G` Number of living units:------------ Number of bedrooms ------------Garba_ge Grinder ------------ Lot Size -------------------------------------------- Water Supply: Public System and name ------------------------ ------ ---------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt ❑ Cl a ❑ , Peat❑ Sandy Loam .i] 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 sewer is available within 200 feet,) :. ,_f ti PACKCAGE TREATMENT I ] SEPTIC TANK:[ ] Size-_ o_- 7---X a----------------- Liquid Depth ----- .-------,----- -- 0 Capacity -C�__O? pe 4ONC9e—f1 Material �IS - No. Com artments7--_ VI Distance to nearest: Well ----t b S--l--------------ImAF6 dation ------------ Prop. Line -------- N 'l t. t LEACHING LINE [ ] No. of Lines _____------------------ Length of each `line'4t;Qf;-l--,Sue", - Total Length ----�PP�o------------- 'ep-r7 ittjam �. „ 'D' Box .�"------ Type Filter Material '€'I'�-�---�h Fitt Material ------------------------- Distance -----------------------Distance to nearest: Well ----1-33-----_-----_ Fou'ndaTian -.20-------------- Property Line,------------------•----- C SEEPAGE PIT [ Depth � ' --- Rock Filled Yes No h --- -------------- Diameter ---------------- Number+--.----- -'- ❑ Q Water Table Depth ------------------------------ - Rock Size--------------------------------- Distance to nearest: Well ------------------------------3� -ia` 1K i'Foundation -------------------- Prop. Line -_--.----------_--- ai v--3►'�' t -REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------ 'Date - -- -------------------------} Septic Tank (Specify Requirements) ----------------------- Disposal Field (Specify Requirements) ---------- -- ----------------- --------------------------------------------------------------- I ----------------------------------------------------------- ------------------------------------------- } ------------------------------------------ - - - (Draw existing and required addition on reverse side) ;. I hereby certify that 1 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 liven- ' 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 L- . L-- R Q ®o-�`---- --#3q I------- Owner ------ Title - - -------------- ------ ---------- ---- (If other than own R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY vL� --------------------------- ----------DATE BUILDING PERMIT ISSUED --- _ - DATE - ------------ - ------ ---- ADDITIONAL COMMENTS �s�-----.P�-------� ----�----`-- '�- --0 - -------------- �3 7 -- ---- --- ---- -- - / --------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------- ---------------------------------------------------------------------------------------- -------------------------- ------------ ------- at ------------- Final Inspection by Date fr - �� SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M