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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT O0 = ----------------------- ------------------ I (Complete in Triplicate) Permit No: 70 - ----------- This Permit Expires 1 Year From Date Issued Date Issued �__� o �Z� Applicafion 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ i- - - --- - �-=� Vis„-- ---- --•------ - -- -- - CENSUS TRAC? --------------•----------- Addressl Name -_.__ --•----------------------- --- - ----Phone -----""-"------ -- Own ----- --------- sl -'- - --- ---- 140,; ---- City Contractor's Name __ "_�*-�_•�__ - ---------------------•----------License # f ----- Phone Installation will serve: Residence XApartment House-E] Commercial ❑Trailer Court ;❑ Motel ❑Other______________ Wat b SUof living units: Number of bedrooms __y____Garbage Grinder _--_`______-_ Lot Size * Va j I,pply: Public System and name ------------------------------------ ------------------------------------------------------ Priate - --- ---------•----- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ClayLoam-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' ithin 200 feet,} PACKAGE TREATMENT i f [ ] SEPTIC TANK �J Size__— ---7L_. �-------------------- Liquid Depth ----o ---------- y� 9 Capacity:, + -- Type �'`'�rr'~ " Material_ - - No. Compartments __-_-_ .. - \' ---- Distance to nearest: Well,9S70_P -------- -----------Foundation -----4P-1---- Prop. Line ----- LEACHING LINE 6,d� No. of Lines -----_________---------- Length of each line__-f O_®-r - Total Length 'D' Box ^ ______ Type Filter Material ',, C&e th Filter Material __-__/8'Po --------------- - -- ----•- ! Distance to nearest: Well -_� D. .4 ; --__- " ion -Q------------- ---- Property Line -----!- - ----- •---------- SEEPAGEPIT L 1 Depth -------------------- Diameter ---------------- Number ------__`------------------ Rock Filled Yes 1-1 No 0 " Water Table Depth ------------------------------------------------Rock Size --_-------------------•-•- - Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line --------------------•- I RE�ApRI /ADDITION(Prev. Sanitation Permit# --------------------------------- -",_-__ pate _"_------_----" _--_-- - _- -------------------------- tic nk (Specify Requirements) - --------------------- - --- r Disposal kield (Spe ify Requireme it ) _ -___ - +� t -- Q -- ---- -- ?f-".'----- ------ --I - --------- -----�a►f/---- ----- -------- 0-A- ---------"--_- -------------------� 'S. ----------- '�- --------------------------------- --------------------------------------------------------------- --------------"------------- (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�DisfFic#. Home owner or licen- sed ageritslsignature certifies the following: L._. "I certify that in the performance of the work for which this ,mit is issued, I shall not employ any person in such manner p g e subject toMman's Co ensation laws of California." I Signe as o e o p By - ------- --- ------------- Title - ------------------- -- (If other than owner) FO 1MTMENT USE ONLY t APPLICATION ACCEPTED B s___ _ --"--- ------------------------------------------------------------------------ DATE BUILDING ERMIT ISSUED - fIO- � ---`�-b-- --------- ------------------------ � � a - - -------- - -------------•ADDN N �- ilk ,------------------- Final Inspection bY ------ _ .---------------------------------------------------------------------------------------- ------------- ---------------------------------------Date -1Ca` .-- I� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 !1-'68 Rev. 5M