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- - 1 ISR OFF1 E USE: APPLICATION FOR SANITATION PERMIT . j Permit No. --------- (Complete in Triplicate) --------------------------- - Date Issued ....�r�- _ This Permit Expires 1 Year From Date Issued �� ------------- D?f — (aro -- 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 a in compliance with County Ordinance No. 549 andexisti g Rules and Regulations: / "--_� NSUS TRACT -------------------------- JOB ADDRESS/LOCATION - Owner's Name ------- - • ._ Phone ----�`�-Z1�'.---••--- a_ �L- - ..._,_ citY ----- ----- L�.,9'."-f_✓..!`�----------------------------------------- ------------------License #�� =-�-•- --- Phone ------------------------------ Contractor's Name --------------- -- --�'��X�------------ ----------------- Installation will serve: Residence ❑`Apartment House❑ Commercial ❑Trailer Court Motel Other ----`---,-�---- ------------------ _ ` -__..-- Lot Size ----�s-.�G ---- �-�` Number of living units:_ Number of bedrooms ...^------Larbage Grinder ..--. � - -----------------Private ❑ Water Supply: Public System and name [ -Yp, l.(/ .1'- El Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ .Peat X Sandy Loam ❑ Clay Loam o Hardpan E] ,riAdobe*.X,Flll 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 �epagepit permitted if public sewer i�a ailable within 200 feet,} If Size- ,.S-''L` - fQ ---- - Liquid Depth r-------------------- PACKAGE TREATMENT SEPTICTANK'[`], _) ' Capacity _ TYPe --- elf-'7MaterialAl-w ._ No. Compartments - �-------•----- Y d GvJ - vac- - Pro Line Distance to nearest: Weill/'""------------ Foundation . . P Length of each line. ._ � _.A- Total Length ,-��.-- `- LEACHING LINE No. of Lines ------ - g --- JP /+� � epth Filter MSsteri'l ----- �--------- Jori, "- ^- + ! 'p' Bax -- -"""" Type Fitter Material�l""�?-� -� , t I f� f. _ l 4f--- Property Line _—.�l�~•:- Distance to nearest: Well ___-1-_6/ --- Foundaton _. ._ .". ---- P nY ' '` Rock Filled Yes`; No 0 ' SEEPAGE PIT [ ) Depth Diameter -- ----- - - Number...------ --- ---------------- ' f ;% . Water Table Depth -- ----_- ''Rock Size xfn - ------------------------- - 405 FDistance to nearest: Well.---------------------------------� Foundation --:----- Prop. Line ... ----------•--- REPAig/ADDITION(Prev. Sanitation'Pefmit#-,- Septic Tank (Specify Requirements) ---------------------------------- - ------------------------------------ - ------ .. , ------... ------------------------ --- ----------- Disposal Field (Specify Requirements) -------------------------- - " i r- �. --- ---- ------------------------------ ---- ------ ' = --------------- r ; Yd l,._.-.__- ------------------------- ---'------------------------------`----_--_-------•`""------"_"--------- ----------ti- # �. (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_o_r_11r. icen- sed agents signature certifies the following: �, ,� 't. '�-�� ' ¢# an "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."I Signed --------------- --------------------------------- =_ ----------- Owner r ------------------------------ (If --------- - Title .-- �'-"''- ---- ----------- ----------'---- --------' -----�-.-•--�-_ - BY ___ _ - - ---- - - ----------- ------------------------------ (If other than owner) -�.�,,"• � • �y ' ..---- FOR'"DEPARTINENT USf~ ONLY APPLICATION ACCEPTED BY _. �,�. `r yG --------- _ DATE ------------------/y-'6!�'- ' __ � DATE ------------------------------------------- BUILDING PERMIT ISSUED --__ E% .fir _-- "--- -- -� ' - _. . . •�,— ADDITIONAL COMMENTS -------------- ---------- -- -- --------- -------- "I -------------------------------- ------------------------------ - - - ---- , } -- -- d: =' ------ --------- '----------- - ----- � Date -- ---- ------------------- - - Final Inspection by: "" _ _R SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M