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FOR OFFICE USE: , �� 6—7 0 APPLICATION FOR SANITATION PERMITp --- ----------------------- y0 Permit No. ---------------------- (Complete in Triplicate) lG �r -------------------------------- Date Issued/19��_-lP__-_7v ------------ ----------------------------------------_-- This Permit Expires i Year From Date Issued t 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: JOB ADDRESS/LOCATION --2_-fQ---63--��-y- F------- '---------1-4 ------ ----- CENSUS TRACT -----------------------_. Owner's Name _� AWD------------ h---------------------------------------------------------------------------Phone ------------------------------------ Address 4 / 1 - - city ----------------------- Contractorq Name ------ .s e ,L----------------------License # _I _ J-__ Phone Installation will serve: Residence 6�Apartment House❑ Commercial ❑Trailer Court � Motel ❑Other ------�----- _------g-----------------lv�-- Lot Size __a2_',t�`��L�---------- i Number of livingunits:___. ---__-_ Number of bedrooms __ Garbo a Grinder Water Supply: Public System and name ------------------------------------------------------------------------------------------ --------------------Private Character of soil to a depth of 3 feet: Sand' Silt Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ;❑ p ❑ ❑ Y Hardpan ❑ Adobe '❑ Fill Materia! _____-____ If yes,type ---------------------------- (Plot __________________________(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 flank or seepage pit permitted if public sewer is available within 200 feet,) ' r le {/J PACKAGE TREATMENT [ ] SEPTIC TANK Size_-- ` ____________________ Liquid Depth _.__-��'.___-____.___.. Capacity Type Material e4�'YeYWNo. Compartments d"s_________________ Distance to nearest:-Well ,__`__ ___!_______f ` ____Foundation ____/a--_- Prop. Line ___ _`_____________ LEACHING LINE [:J No. of Lines ---r__,-Z__---!---- Length of each line-------T>z ------------ Total Length ,__ to--- ___-__-___ , 'D' Box S_ Type Filter Material _11' � ___Depth Filter Material ____ Distance to nearest: Well ___gip__________ Foundation -/10--------------- Property Line. ----------- - r SEEPAGE PIT �(] Depth __a ~_-_------- Diameter__________ Number _.___-. _._- Rock Filled Yes No IWater Table Depth -----'�-��---------------------------------- Rock Size - - �---�---�------------ Distance to nearest: Well _--104-- -------------------------rFoundation --1-4?----------- Prop. Line -- ----:-------- REPAIR/ADDITION(Prev. Sanitation Permit# -•----------------------------------=--I---- Date ---_-----------------------_.-----) SepticTank (Specify Requirements) ------------------- ------------------------------------------------------------------------ ----------------------------------------------- ! 1 Disposal Field (Specify Requirements) -----------------------------------------=-------------------------------------------------------- --------------------------------- 4 I Pt ------------------------------------------------------------------------- ________________________________________________________________________________________________________________________________________________________________________________________________________ (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, dome owner or licen- sed agents signature certifies the following: t "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." Signed --------- --- - - On ' Owner f BY ----- - ------------- ----- -----. ------ Title ----- --------- ] oth wner] I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------------------------------------------- DATE A0—_?_A-7 ----------------- BUILDING PERMIT ISSUED --- --- ------------------------------------------------------- - ---------------DATE ------------------------------------------- ADDITIONALCOMMENTS -------------- -------------------------------------------- ---------------------------------------------------------------------- ----------•---------------- -------------- --------------- ------- ------- ---------------------------------------------------------------------------------- ------------------ - _ R =. Final Inspection by: `- ----------------------------------------Date --- ---- ------- ------- - - - C' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M