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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - - - •------------ E'h (Complete in Triplicate) Permit No. ..7_L-_--9- _J- ---------- -- -------------------------- ---------------- h ___ --------------- ------ 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _12-=�d ------ �Q. _-�------------------------------- -----------CENSUS TRACT ------ ------------------- Owner's Name �/• 's /LIJrPE� 7� C? �1�/� -----------------------------7-------------------Phone.�`�:77:07'y1 Address ---S it----- ------------------------------------------------------------------------•--•--. City --------------------------------------- •-------- Contractor's Name ---A&---S e,--Z2W_e----------------------------------------License # 17.7,W_3------ Phone ��e .---------- Installation will serve: Residence (1 Apartment Nouse❑ Commercial [7]Trailer Court ',❑ Motel ❑Other -- ----------------------------------------- Number of livingunits-.-j ------ Number of bedrooms __.` Garba a Grinder �--- 9 W-©----- Lot Size ....................... Water Supply: Public System and name ------------------------------------ ___Private ❑ -------------------------------- Character of soil to a depth of 3 feet: Sand'k] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ 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 [ ] SEPTIC TANK ki Size... �_``-------------------- Liquid Depth _y_ 0_________.______-__ 11 TypeMaterial_ No. Compartments �_�__ _______________ Capacity �_ -�. �- ��_%��. _��9_ _ _ Distance to nearest: Well -_-------------------------Foundation ------------ Prop. Line '`'`________......_ p LEACHING LINE ] No. of Lines _____r_______________ Length of each line.----74�__e------------- Total Length ___'' �__�_.__..__.____- D' Box ____ Type Filter Material YP ---- Depth Filter Material __447 - -------------------------------- Distance to nearest. Weil ---n7------------- Foundation _.LW_`1.________ ert ___ Property Line _J__'----------------- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number -------------------- ------ Rock Filled Yes ❑ No I❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line -------------- -------- REPAIR/ADDITION(Prev. Sanitation Permit e# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) -------- -------------- ---------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ---------------------------------------------------------------------------------------------- --------------------------•----------- --------------------------------- -- -----------------------------------------------------------------I------------------------------------------------------ --- ---------------------------------- (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 rmance ofthe work for which this permit is issued, I shall not employ any person in such manner as to becomes ark n's Compensation laws of California." Signed -!,#hn ------------------------------------------------------ Owner BY ---------- --- ---- ----------------------------------- Title ----------------- ---------------------------- --------------- --------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------- ---- ------------------------------------------- ------------------------------------- DATE ---/O/Z!- 7l BUILDING PERMIT ISSUED w,-19 � _ DATE ADDITIONAL COMMENT _._ ;`~". -mac C> G�fc�x_. c-1d_fes � C-v ,-------------------- '! --ow-4 -------------------------------------------------------------------------- ------------------------- ----------------------- ------------ ------------------------------ -- - - ---------- - -----------------------------------------------------`- �-------- - �------------- Final Inspection by: _ Date - ------------------------- SAN ----- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M