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i FOR OFFICE USE: , _ APPLICATION FOR'SANITATION PERMIT------I------ , (Complete in Triplicate) Permit No. ✓i- ,/ -._______--_-_--_--___-- This Permit Expires 1 Year From Date Issued Date Issued 97�-41.f 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: / MTGf} . JOB ADDRESS/LOCATION .� (15/_-Z�.___,_-_� ;-___el of_____i,,l� f `s,/ _-__"`CENSUS TRACT ------- Owner's Name -- �'- fie�F------- �-------------------- _ ----------------------------------------,------Phone Address ----3_ Q --7-4P(4_ - 'f �/ -S '� fieyylc�s«+ j - .. . City --- - - ----- - � ----------- N Contractor"t Name ! w? '�_f.2_'�y-` �`� Vin!- -------- License O / / - ----. Phone - .-- !-05.5.' Installation will serve: Residence U2-Apartment House/❑ Commercial ❑Trailer Curt ❑ Motel ❑Other Number of living units:--- Number of bedrooms ' Garbage Grinder - Lot Size .- �1 - Water Supply: Public System and name --- - --- ----- ----- a Private }'' } Character of soil to a depth of 3 feet: Sand' S Clay ❑ Peat[] Sandy Lom ,- Clay Loam [] Hardpan ❑ Adobe E] Fill Material _N __- If yes,type ----------------___-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. 11 st be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availailAvithin 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size___t_- - °- -- ----- t ® f j__-- Liquid Depth ---------qr Capacity `------ Type .� __ aterial No. Compartments tante to nearest: Well ____ ----.---•-----Foundation ` _ �_-_------prop. Line -_tel-_ LEACHING LINE No. of Lines ' [ --- -�----- ;. _ Length of each line_-_.-1_49i1 _ -_ ___ Total Length ,__--_ --------- 'D' Box ------------ Type Fillfer Material - _t;K,le__.---Depth Filter Material -__-_--- ___ . r - r Distance to nearest: Will -_ ----------- Foundation _ Property Line __-___ SEEPAGE PIT [ Depth 1 _____ _ ,Diameter 4-�. _ r_-- Number --------- --------- --- Rock filled Yes Zj--''No Water Table Depth;'-------- -Q--- •--- ---------Rock Size Y Distance to nearest Well _____________________---------------Foundation -------------------- Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation Permit/# ------------------------ Date -------------) Septic Tank (Specify Requirements)------'---------__ ------------ ------ - --------•--- ---- ------ Disposal Field (Specify Requirements) -------Y- -. --- --� -- -------- ------------------------------------------------ r -- ----- (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 thb work for which this permit is issued, I shdH not employ any person in such manner as to bec jec o Workman's Compensation laws of California." - jeX Signed - --�-. --------------------------.- Owner BY - ------ ------ Title . -- -------- - - - (If other than owner) FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY -T_,t_R- 0----------------- BUILDING PERMIT ISSUED - DATE -7 f ---- ----- - ' XR "X jz� DATE ADDITION L CO,MME TS------- -_ �__ -- . ,Tr ---jq �_ r.U. - ------•--- ---------- - -- ---------------- --- - ----- --- ---- - ----------- - -- - ------------ ----------' - -- -----------'------__-__--•---------------------'---- FinalInspec i - --•- ------- ------------------------------------------- ----------------- - =------- p _--- ---- - -------------------------------- -----------Date ------ ------- SAN JOAQUIN LOCAL HEALTH DISTRICT / E. H. 9 1-'68 Rev. 5M