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FOR OFFICE USE: APPLICATION FR SANITATION PERMIT / 'a( _� - �,' .� - ,-. Permit No. ---_ (Complete i.tp Triplicate) = t' - Date Issued � -�7.._b,� - �-- -_-- _____-_-_---- 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 -` �� _w--t-vA-- �-eS,�'') -----------------CENSUS TRACT -------------- ----------- Owner's Name ----------------------- - 30xm--Ls-------`- Sf' -------------------------------------------- ------..Phone - ----------------------------- Address ---------------------------------- ( �ja-![-vukx--------------------- City -----:-153`C7C tT _t --------------------------------------------- Ph ------------------------------------------ i Contractor's Name -' ;-fi -d-°---__ _ 'E'_C`' P = f�- -----------------License # �� Phone Installation will serve: Residence [,Apartment House❑ Commercial E],Trailer Court I❑ Motel ❑Other ------------------------------------------- Yq ae-ce- �j Aaee- 1c�� Number of living units:_------------- Number of bedrooms -_I�-----Garbage Grinder 140--- Lot Size -___.--__---__-------------- .------ Water Supply: Public System and name ----------------------------------------------------------------------------------------------------------Private, Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ y Hardpan ❑ Adobe 2� Fill Material ------------- If yes,type ------------------_.---__-_ f (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,) � i PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size------------------------------------------------ Liquid Depth -------------------------- Capacity -___- --_.Capacity ---/V60----- Type -------------------- Material----ee- -- No. Compartments -----Z-..---------- ON f .11 / 1 Distance to nearest: Well -------460----------------------Foundation __ad------------- Prop. Line--- �d----.----- LEACHING LINE [ ] No. of Lines --------Z______-_-__ Length of.each line----___---- _-_-------- Total Length ----I:q�'.............. v ' 'D' Box _X----_ Type Filter Material --_----------------Depth Filter Material -------------------------�-------------: � Distance to nearest: Well ------ --------- Foundation ------------- -_ Property Line SEEPAGE PIT [ ] Depth __- s--_-_--------- Diameter - fV-.-,__- Number ---------------------------- Rock Filled Yes K No .0 WaterTable Depth ------------------------------------------------Rock Size --------------------- ---------- Distance to nearest: Well ----------0o-------------------- -Foundation ------ $0----- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----_---_-__-----.____--.__----_I jSeptic Tank (Specify Requirements) -------------------------------------------------------------------------------- ---------------- ------ DisposalField (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: "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 beclg+ e subject t Wo man's Compensation laws of California." !! -- ------ Owner Signed ` By ------------ -------- --------------- ---`"-- - ---------------- Title ---------------- ------------------------------------------------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -WA .As-A--�------------------------------------- -------------- DATE ---- -------------- BUILDINGPERMIT ISSUED ---------------------------------------------------------------•----------------------------------------DATE ------------------------------------------ ADDITIONAL COMMENTS - -- rr_�� ------------------ ----------- ---------------------------------------- ---- - ------�--Zb----- -------------------------------------- ------------- --------------------- -------- ------------ --------------------- - ----------- -- r Final Inspection b ---------- 4 °- -� Date" f b - r��t - P y: ------------------- 4�'� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.