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S FOR OFFICE USE 4 APPOQA TICWFOR SANITATION PERMIT Permit No: :___�3' (Complete in Triplicate) � ate Issued - 5 )-) '7..3 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. CENSUS TRACT __________________________ Owner's Name ---,/-1 ----/51 / `--------------------------------- ---------------- ------------------------------------Phone ------------------------- ------ Address ----'7`f�-� - 4UP, -----Z)�V-------------- ------------ City � .............. Contractor's Name ___�6f ,_____.License -_ Phone _�_- - -_ Installation will serve: Resident partment House❑ Commercial ❑Trailer ourt i❑ Motel E]Other -------,-�=-Y�-�-f'-'�=----�-�. 1 z � C7 lst v Number of living units:--- ----- Number of bedrooms g `.� /� 7`-- . ;�_.-__Garba e Grinder _________ Lot Size _'_ _____ _______________________ Water Supply: Public System and name ------------------------------------------`-------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt-❑ Clay �[ Peat E] Sandy Loam E] Clay Loam i❑ Hardpan E] Adobe'❑ Fill M`aterial ____________ 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[ J Size____. X----5___X------ Liquid Depth ----:.�'�__-_________ O Capacity _1200----- Type `�_..' Material.___C.( 1'_.__ .No. Compartments ----_��--_.... . Distance to nearest: Well _______ - Oo____ __________Foundation __/__�_____. ' � �----- Prop. Line ------ ------ L. LEACHING LINE No. of Lines Length of each` line-__/C9-t -------------- Total Length ' D' Box __ Type Filter Materia Depth Filter Material ------11!S_11 ................. rf� Distance to nearest: Well .. ----------- Foundation --------- Property Line_ ......... SEEPAGE PIT [ ] Depth ----4%_7----- Diameter _3.6_er-__ Number -----------I/ ________ _____ Rock Filled Yes No C] Water Table Depth ------ --r___________________________Rock Size _ _ .�sl --:__ �- .—:-�- Distance to nearest: Well -----��___---------------------Foundation -_Z0_74------- Prop. Line _... ................. 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 i 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, 1 shall not employ any person in such manner as to beco su Iect to , or man's ompe tion laws of California." Signed ---- ---- - --- --- --------- ---- -=--------- -- ��_�-�Owner By -----=-------- -------------- ----- - ----= Title --------=-------------------------------------------------------------- j (If other than ow er) OR .DEPA MENT USE ONLY APPLICATION ACCEPTED BY --- -- ------ - ---- -------------------------------------------------------------------- ---- DATE ----- BUILDING PERMIT ISSUED ------ - ----------------------------------------------------------- -------------------DATE -------------•----------�� --------- ADDITIONAL COMMENTS - ----- -- -------------------•--------- - ---------------------------------------------- -- --- ---- ----- ----------------------------------------------------------------------------------------------------------------d--- ----------------- -------------------- ------------- -- -- -- -- -- - - --- --------------------------------------------------------------------------------- Final Inspection by: ----- - ---- - --- - - DateN ------ -- - - ------ JOAQUIN LOCAL HEALTH DISTRICT 1 3 E. H. 9 1-'68 ev. 5M