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e_ FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT " - ---------------- Permit No. 71" -!--Z ,-- - (Complete in Triplicate) ---------- -------- `=-------' : ___________________---------+_-----------_________ _____ This Permit Expires 1 Year From Date issued Date Issued 04�0-6 L/ 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: _�5 b"7�_, S • 4LSCC_ -•(_a.) Ar,.c—o'r_10ry�+ j�� JOB ADDRESS/LOCATION,5'0,__ l-----�Q,-OF--,(-t9,�(�7`�',$'--�,,SG�/P�/X� AVENSUS TRACT ________`S:. Owner's Name l f ------- d �--------------------------------------------- ---- - Phone ------------------------------------ Address ---`lily'� G�, --------JeO9------------------------------ ------------ City -------------------------- ----•- Contractor's Name ------- -------SE r---- ----------License # ----- Phone Installation will serve: .", Residence_T Apartment House❑ Commercial ❑Trailer Court ;❑ Motel.❑ Other --------------- ------------------- ------ _ Number of living unitsc_____ ____ Number of bedrooms __:____Garbage GrinderLot Size _f__ =' ___________________.:.__- Water Supply: Public System and name ---------------------------------------------------------'r -------------------------------Private ❑ O Character of soil to a depth of 3,feet:. Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ N I 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,) PACKAGE TREATMENT f ] SEPTIC TANK'[ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity _--_---------- -----Capacity ----------- --------- Type ---------- --------- Material------"--------------- No. C mpartments -------------•-------- Distance to nearest: Well _____-_____ _ I - -----------------------Foundation ------------------ --- Prop. Line --------•--------..... LEACHING LINE [ j No. of Lines--`-J_----------------- Leng h of each line---------------------.______ Tota Length _.__________________________ +�tµ. D'`Box ------------ Type Filter Mated I ___________________ Depth 'Filter Material --------------------•.................... --- ! ,'�_ Distance to nearest: Well _____________ _________ Foundation -----------------------_ P operty Line ________________......._ SEEPAGE PIT ` [ � Depth ____________________ Diameter ____ __________ Number ._____._#____________.____ R ck Filled Yes ❑ No 0 a Water Table Depth - ---- - Rock Size - - ---- - ---- to nearest: Well --------_---•- - - -----------------_-Foundation ------------- -- _ Prop. Line)------------------_-- REPAIR/ADDITION(Prev. ----------------__-- REPAIR/ADDITION{Prey. Sanitation Permit# -------- ------- _ ____________________Dated__________________________ _____} y Septic Tank (Specify Requirements) __________________ - --------------------------------------------------------^---------------------------1------------ F Disposal Field (Specify Requirements)---'- ----- -----pz�?---- -------------- ------------------------ '-------------------------------------------- ------------------------ 4 ----- -------- - ---------------------------------------------------- (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 r 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 not employ any person'in such manner as to become subject to Work n's Compensation laws of California." Signed --------- ---- -- - - ----- -- -------------------------------------------------- Owner By -----------------V� --------- r --------------------------------------------- Title --------- ------------- ------------------------------------------- - �f othe an owner) a t �� DD nn FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -___-_1__`A--------------------------------- --------------------------------------------- DATE -----1-I_"_ ;� -------- BUILDING PERMIT ISSUED ----=-------------------------=:---------- -- - --------------------DATE ------------- ----- ------------------------ ----------- -------------•-------- ADDITIONAL COMMENTS __- ____ __ . - 1 ----------- ------------------------------------------------------------------------------------ --------- ----------------------------------------- ---------- - ------------------------- --- --------- -- - -- ------------ ------------------- ------------------------------------------ ------ ----- -------------------------------- ------ ----------- ------------------------ ------- ---- - -------------------------------------------------------------------------------------------- ----------------- ---------------- ----- -- - ---- - --------------------------------- --------------- Date _... Final Inspection y: _._ x. " ----- -- -- --- - - - - SAN JOAQUIN LOCAL HEALTHA,DISTRICT E. H. 9 1-'6$ Rev. 5M j