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FOR OFFICE USE: --� - -- �a APPLICATION FOR SANITATION ;KNIT ------ !" °" (Complete in Triplicate) Permit No. _7U.- - _- _. ---------=------------=--------- ------------------------ � _ _ _ __ ------------- This Permit Expires 1 Year From Date Issued Date Issued -_.___ 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 comph nce-with,County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . ,---(f-!I7.!- "' - d"� E ---, r�--CENSUS TRACT / Owner's Name ---- - -/�� -- — 161/ # -------------------- Phone -------------- Addressi I VVe- s City ..- -------------------------------------------- Contractor's Name - A1C- Z-ko---------------------------------------License # -- - -;- - Phone Installation will serve: Res iclerice .Apartmen5t House-[] Commercial :❑Trailer Court ',❑ Mote! ❑ Other 4-4e-—6`71 _._ Number of living units:.-l---- Numbers of bedrooms __ -----Garba_ge Grinder -*,P-.. Lot Size L2AC*-'*Z -&---------------- Water --- ------------Water Supply: Public System and name ------------------ ----------------------------------------------------------------------Private ' Character of soil to a depth of 3 feet: kSar'd'❑ Silt; Clay, [] Peat$ Sandy Loam Clay Loam .[] Hardpan ❑ Adob T❑'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 septicjank or seepage pit permitted if public sewer is available within 200 feet,) a PACKAGE TREATMENT [ ] SEPTIC TANK �: Size _- ~ I..-._---_- Liquid Depth - Capaclitya7'I� --- Type-- - Material) -"------ No. Compartments - --.! 11 --.---. -_ i___ { ol Distance to nearest: Wel! ---.-- / --- -- Foundation Prop. Line ., LEACHING SINE ] ..No, of Lines --.-- .-_-___-__-___ Len th of each line____. 49 N s g ----�.; Tota! Length ,_ ---------------- /�, 'D' Box1Y.B.,::5;- Type Filter Material IX; Depth Filter Material -/ '''-------._---_.------__.__--._ Distance to nearest: Well ------- Foundation .ZP-------------- Property Line 111�94C9--`._-_-- SEEPAGE PIT Depth ----- Diameter ---------------- Number - Rock Filled Yes El No 13 Water Table Depth ------------------------------------------------Rock Size -------------------------------- �'. Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------- ....... I REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date ----------------------------_---.-1 Septic Tank (Specify Requirements) --------- ------------------------------------------------------------------------- -----------------•---------------------------- Disposal Field (Specify Requirements) ----------------------------------------------- --------------------------------------------------- ------ ; - --------------- ------- ----------------------- ---------------------------------------------------------------------------------------------------------------------------- t (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 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 Workman's Compensation laws of California." 4. Signed _ Owner ------------------------- By --------------------- -----`--------------------- Title ------ t�'fLt....- -- -------------------------------------- (If other t owner) FOR DEPARTMENT USE ONLY DATE � o------------- APPLICATION ACCEPTED BY --�=- --------gr'�-----�'--- -��.t '�"�---- - - -- -------- - �----�BUILDING PERMIT iSS�IED -�- ------------- - DATE ---------------------------------------------------------------------- ------------ rADDITIONAL COMMENTS .-_.--_-__.._-_--.-------- --- ! f w' --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------ a ti .: - ' -- - -------- -- -------.Date Fit-ial Inspection by: ------ - - -�5 _--.---' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M • '. 4 i