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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT V-1121'-3-10 (� � Permit No. --v-�-. y (Complete in Triplicate) 7--'� - -------- ----- _.--------------------__________ __� This Permit Expires 1 Year From Date Issued Date Issued �(i_t_ v2--Zr� --------- - ------------- 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 mp de in coryrplian¢ with C nt rdinance No. 49 a e i tin, RuI s Regulations: - PP 7 C�-f C1 t 1 iyt-� �-7 � Y=j r 'P. v,r t e u it JOB ADDRESS/LOCATION .-_---- LL -_______ ----- __._____ _____ ZU----.-- CENSUS TRACT�A.kjesu----.C,IC Owner's Name -----4WAt---------- / '_C. ----------------------------------------------------- -------------------Phone __75_-7'-/- `fir ....... Address -----------------4,31,---------- -* 4Z4-------------�k-.----------------------. City ,,.4xlr ------------------------------------•------ Contractor's Name ------------------------ joSSL_V------------------------------------------------License # ------------------------ Phone ------------------------•----- Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:----/__--_- Number of bedrooms __t�_.-_-Garbage Grinder --Wg---- Lot Size ___�z,r?__-_____I'S_____r![a-�" ------ . Water Supply: Public System and name -----C..% ..----------am-�`�._t--_-.--_._----_-SP__1r_tr4,�---�_,----------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [X► 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.) l� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,)ol �+ PACKAGE TREATMENT SEPTIC TANK; Size___ �� ' - [� [ ] -- ------�--.�-�- -�-•-/a-z--- Liquid Depth _.---- - - ------------- 1� Capacity ---1�.p_p----- Type �ra_Cgs_ _ Material_____C_G-_______ No. Compartments ____we.............. Distance to nearest: Well -----P/A----------------------Foundation -------40---- Prop. Line _____-�T:..-__._.... LEACHING LINE [ No. of Lines -------/--------------- Length of each line---------------------------- Total Length ,_____PO- 0 ._.._.._ D' Box _A/p--- Type e Filter Materials_+ -----Depth Filter Material Distance to nearest: Well ----A/)A/) %----------- Foundation -------Zia_r_______ Property Line -_____�'............-- SEEPAGE PIT [ij. Depth ----:c� t� . ___._ Diameter ___,.�„�_______ Number __________ -------------- Rock Filled Yes [& No i❑ i Water Table Depth ---------All—A-----------------------------Rock Size ------- ....... r Distance to nearest: Well ------N1*4--------------- ---------Foundation _-------1-0---.___ Prop. Line .......I`__._.----- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date __-_-_-______--___--___._.._____) Septic Tank (Specify Requirements) _-----------------------------'------------------------------------------------- ------------------------ ------ Disposal Field (Specify Requirements) __-__-__-__ -------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------=------------------------------------------------------------------------------------------------------------- (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: "1 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 b ome subject to War 's Co pensatio laws of California." Signed ---- i Owner BY -------------------------------------------------------- -----=---`----------------------------------- Title ------------------------------------------------------------------------ (If other than owner) MR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C'-43-Y------------ --- -------------------------------------------------------------------- DATE 14-----2= ------- - - BUILDING PERMIT ISSUED --------------------------------- -- ------------------------------------------------------------------DATE ------------------------------- ----------- ADDITIONALCOMMENTS --------------- -------------------------------------------- ----------- ------------------------------ ---- I--- - --- - - --------------- - ---- ----------------------------------------------------- - ---- -f ------------------------------- ------------- - -- - - ----------------------- -- --------------------------------------------------- ---- - - 7- -----------Final Inspection by: - ---- - ------------------------ -------------Date ------ �� ; :� SAN JOA UIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M