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FOR OFFICE USE: APPLICATION FOR SANITATION :dMIT a`--rS'71-- Permit No. -;7 (Complete in Triplicate) lC 1 - --- Date Issued ----------------- ------------ This Permit Expires 1 Year From 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 ins, ade in ccoom Iia wi ount r 'nan o. 5 9 and existing Rules and Regulations: `f sig rr� _ *9 V CENSUS TRACT -------------- -------- JOB ADDRESS/LOCATION __- ------1' - --------- - Owner's Name ---- /�-1'_�I/vi_'_' Mei-- --- ICJ --- �'--------------- Phone ------------------------------------ jam . Qp Address / � a ---------------------------- - City k- Contractor's Name --------------------- CG1!ZP �--------------------- License # - Phone Installation will serve: Residence ❑Apartment,Holusse❑ Commercial ❑Trailer Court ;❑ Motel ❑Other __L-- Gar---� Number of living units:---_-_ Number of bedrooms __-_ ____Garbage Grinder _" _ Lot Size -_____ ____ _____ ____________________ Water Supply: Public System and name ---------/04s1111aw--------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat g 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 [Ljol, Si ---X------------- --------------------------- Liquid Depth -- --.--- ---------- ----- Capacity -la -_ Type/ aterial C�/ No. Compartments -G7 ------ Distance to nearest: Well ----- - - - - ____ - --- --------Foundation ______________________ Prop. Line -___ - ---- ------- LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ____________________________ 'D' Box - Type Filter Material --------------------Depth Filter Material _________________________________________ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ______-_______-__._---- SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No ❑ WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ___-_____--_____--__-_-_____-----) Septic Tank (Specify Requirements) ------------------------------ ------------------------------------------------------------------------ -- - - ----------- ------- Dis osal Field Specify Requirements) ' (7 /�'= ------ - -- - - ---- --- ---- - -x�--� ---"y ------- ---------- - --- - ------- -------- -- _ �®'t- - - -- ----- (Draw existin 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 the work for which this permit is issued, I shall not employ any person in such manner as to becom ject to Wor 's Compensation la s of California." Signed t .u�- -v ------------ --- - — -----------f----------------- Owner By . .. ----- ------ �r---- ------- ................................................... - ------------------------------------------------ Title --------------------------------- ------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- ---------------------------------------------- - -----------. DATE _.`:�5:-7f-.------------------- BUILDING PERMIT ISSUED - -------------- -------- -- --- -------DAT -- --------------------- ADDITIONAL ----- --- --- ADDITIONAL COMMENTS " ---- - - -------------------------------- - ` " - -- - ----------------------------------------------------------------- ----- ...-_ -.- -------------------- -------------------------------------- - --------------------------- ----------- ----- ?= ---- --- Final Inspection b _ - ------------------------------ ------------------------'Date ---,;---_ --- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M