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k FOR OFFICE USE: j APPLICATION FQR SANITATION PERMIT 76_7-6P P ------- --- ------------- (Complete in Triplicate) -- ----- ----------- -_---------- -- -- --" This Permit Expires 1 Year From Date Issued Date Issued _�.P/_70 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. 549 and existing Rules and Regulations: lr . JOB ADDRESS/LOC T ON ""- � � � CENSUS TRACT -------------------------- -- - _.. _ . n ; C. Owner's Name - - hone -q�� °�943----- Owner's --------- -------- Address -�51-�--= -- --- -- ------- - - ------- -------------- --- ---•--- City -- - ------------------•,------- -------------- Contractor's Name _._ "_._-- J 3 - - ------------ --- ---------------------.License # o� y17------ Phone - ------------ - Installation will serve: Residence �partment House❑ Commercial :[]Trailer Court ❑' Motel ❑Other ----------- ---------`---- }" Number of living units:--.-/- --- Number of bedrooms --- F Garbage Grinder.--•- ---- Lot Size-, Water Supply: Public System and name -- ---------------------------------------------------------- -------------------------------------------------Private ' r Character of soil to a depth'of 3 feet: Sand'D Silt❑ Clay ❑ Peat E] Sandy Loam Clay Loam 'D Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- s {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 Size- 19,------------------- Liquid Depth ...y--------.---,--_-- I' P Material_ .____ No. Compartments -"."""__ i '�.t Capacity/A.8-0 Type �------- - - �----"---=•--- � I_j Distance to nearest: Well ----Jam'-."---...................Foundation ---/S__--------_ Prop. Line ""_" 4m,_ � I LEACHING LINE c]' No..of Lines ""."""-/------------ Length of each line-----�;74-------------- Total Length ___ a--""_"""""_-- D' Box ------------ Type Filter Material�0"___ _ _Depth Filter Material ------- --- ---------------------------- iS• Distance to nearest: Weil ---._-_-__,_f----- -- foundation Property Line, _____ SEEPAGE PIT [ j Depth -------------------- Diameter ----------____-- Number____.___-------------------- Rock filled Yes ❑ 'No [3 Water Table Depth y_ :- ----------------------------------Rack Size -------------------------------- Distance - ---------- -------------Distance to nearest: Well ---------------------------------------Foundation -------------------- Prop. Line -------.------------ �? 1 REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------- I Septic Tank {Specify Requirements) .------- --------- - x -------------------------------------------•• ---------------- ----- , , Disposal field (Specify Requirements)' ----`------------------------- ---------------------------------------------------------------------------- � ------------------------------------------------ - ------------------------- ----------------------------- ------------------------ --------------- ------------------------ -------------------- ----- --------------------=------ ----------------------------------------_--------------------------------------------------- ------------------------------ ---------- :L Y{Draw existing and;required addition on reverse side) a I hereby certify that I have prepared this application and that the work will be done in accordance with Son 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, I shall net employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------------------------- -------------------------------------------------------- Owner By -------------- ----------------------------- ------------------------------------------ Title ---------------------------------- ------------------------------------- (If other than owner) qd FOR E ItTMENT USE ONLY APPLICATION ACCEPTED BY --- ------------------------------- DATE _- ._I4 `� BUILDING PERMIT ISSUED ---- -------- -------------------------------------------------------------------------------DATE ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------ ---------------- ---------- ---- ------------------------------ - ------------ ---------------- -------------- -"-------------------------.Date ---- Z --�2----------- ---- -- -- Final Inspection by: ------------------ ---------------------------------------- ------------ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1 '68 Rev. 5M r + .w a