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FOR OFFICE USE: APPLICATION ISR SANITATION PERMIT ------------------------ Y Permit No. (Com Trete in Triplicate) ___________________________________________ ----------- This Permit Expires 1 Year From Date Issued Date Issued - - --- � L cl3_o7o ^13 Application is herel?y.,made to the San Joaquin Local Health District for a permit to construct and install the work herein f described. This app4ication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION o _ .__ ______ _4G-,-Kk1AUS TRACT _ Owner's Name _-._ -'�!/l�4� �Lo ---------------�------------ -------------------Phone , --Z .S ---------- Owner's T-6a -------------------------------------- - ---------------------- `---- --� City` Contractor's Name ----___- -4il... L.44-Gt----t--------------- -----------------------------License4# __l1_ 1------ Phone _L1_Q ---- Installation will serve: Residence ❑ Apartment House�❑ Commercial ❑Trailer Court ❑ Motel ❑Other ______ Number of living units_____________ Number of bedrooms ------------Garbage Grinder _-__----- __ Lot Size -_____-_____._____________________--___-___- Water Supply: Public System and name ------------------------ -------------------------- ------------------------------------------------Private Character of soil to aIdepth of 3 feet: Sand'❑ Silt 0 Gay ❑ Peat❑ Sandy Loam K Clay Loam Hardpan ❑ Adobe❑ Fill Material ____ ------- If yes,type ____________________________ (Plot plan,4showing size of lot, fazat!-on bf system elation to wells, buildings, etc. must`be placed on reverse side.) i NEW INSTALLATION: (No sepic tank or seepage pit permitted if public sewer is available within 200 feet,)OP : PACKAGE TREATMENT [ ) SEPTICTANK:% � ------------------------------- Liquid Depth __,.sF_.y_fr____-__- l�. Capacity) 5 Type-15_�T_______ -Material C�-�-_ No. Compartments ---_ __7 Distance to nearest: Well -- '__________________Foundation ._ _f________ Prop. tine ___ ____ _______ 01 LEACHING LINE No, of Lines --------' -e g) --a- ----- --- - Le� th' of each line--------- f------------- Total Length tSa_-___•--•-___-•- N1. DgJWV 0617 'D' Box -1_____-___ Type Filter Material`�_4�___---Depth Filter Material _f_ '----- --------------------- ------ (TI i. ^ 1-f r Distance t nearest:_Well "7L" " Foundation _/�_-f_________ Property Line _ xsEE�4Depth ___fid ._____ Diameter ---__ _ Number ----------� --------------- Rock Filled YesX No i❑ j 5u mfr Water Table Depth --------- —------- -------------------Rock Size f� �rX C� �------------------------ r -- r i Foundation --- - L3 - Distance to nearest: Well _�1 �_z`-__ _ f____. Prop. Eine ------ ------- . REPAIR/ADDITION(Prev, Sanitation Permit# _.__ =___-__ ____ _+ _g;__-_F Date __________________________________) 1 Septic Tank (Specify Requirements) ---I-- ----- 4'r ------------------------•----- -------------------------------------------'-....... _ Dislpos Field (Specify Requirements ------ ---- - ` ------ ------------------------- yj{ - ---------------- ------------------------------------------------___________________ _______ _______________________________________________ __ ____ ____ _________ rani existing and required addition on,r_ever a side) �_� .- --- --�.---------------------- 1 I hereby certify that I have pr pared this-applicationand that the work will begone in accordance with San Joaquin County Ord iridnces,.State Laws,.and.Rules-and.-Regulations of-the San.Joaquin,Local,Health-District. Home owner or-liven- sed agents signature certifies the following: ` "JI 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 -------------------------- -----4 ----------------------------------- Owner By ---- - ---------- rer-4- FOR r-----� ------------------- Title ---------�------------------------------------------------- - -------------- (If oowner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------------------------------------------- DATE ~/ R BUILDINGPERMIT ISSUED ------- ----------------------------------------------------------- --------------------------------------DATE ------------------------------------------- ADDITIONAL COMMENTS ------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Final Inspection by: -------------- -------------------Date ------------------------------------ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M