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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------- Permit No. ---� --- ---�- � (Complete in Triplicate Date Issued -:�- 13-=-7t.. --------------------- ------- -- 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-compiionce•with-Copnty-Ordinance-No -549 and existing-Rules and -Regulations: T}------ ---- ---- ; - -7 JOB ADDRESS/LOCATION d_,___of n a e Rd___ :-CENSUS TRAC between Liberty & Cellier RdPhone 3�Z9-- Q05------------- �, ---------------------- - Owner's Name ��'�' �O� --------- ---------�----------- ----------------------- - -, Cit 'L9 --------- --------------------=----------------------•------ Address --U-3 -tri ne tr e e t ------------ --------- Y Contractor's Name ._$�5 � ,rests ---Santa .,----.License # --- -�-7$ Phone Installation will serve: Residence ®Apartment House-F1 Commercial ❑Trailer Court s❑ { I iMotel 0 Other ----------------------- -----) Number of living units:-__. _.._ Number of bedrooms -_-_--5-----Garbage Grinder.-.-_._ Lot Size __:-8 ---' ---� --------- Number Private Water Supply: Public System and name --------------------------------------------------- ------------------------------=----------------- F Character of soil to a depth of 3 feet: Sand❑ 51t❑ Clay ❑ Peat 1:1,. 'Sartidy Loam .I] Clay Loarr ❑ Hardpan Adobe'❑ Fill Material ------------ If yes,type --------------------------- _^ F [Pl-ot plan, showing size of lot, location of system in relation t"ells, 6uildi c.µirust be placed;on reverse side.) w t NEW INSTALLATION: [No septic tank or seepage pit-p re miffed if pub available within 200 feet,)NEW PACKAGE TREATMENT [ ] SEPTIC TANK Size`;__-,-- ga-].�.4x )__- ---- Liquid Depth ------------------------ 1000 sial concrete 2 -- 6` Capacity TYPeMaterial - ---- No. Compartments Y ------- ---- 4 Founda`i - ------ Pro ' � - - 0- ___ - ---- Total Length -------------•-------- of eacht line.-10. i Distance to nearest: Weli __5�1_ --1_ __ LEACHING LINE [ ] No. of .Lines ---2-------- --------- Length --- --2-OD-1_______•-------- s [ 'D' Box -1-------- Type Filter Material C•-one�r'e-t-eDepth Fi fer Material ----------- ---- -•------ Distance to nearest: Well ----5Q-'--_-------- Foundation -------[----------- - Property Line.:F----------------•-• } n.. i SEEPAGE PIT [ ] Depth 25'T}-------- Diameter -361, -- Number,----2--------------- --- Rock Filled Yes� No I❑ Water Table Depth ---- -_ ---_-.-Rock Size_ i ---------------- c ob° f t Distance to nearest: Well _1-Q�------------------•---- ---•--Foundation F= w Prop. Line i REPAIR/ADDITION(Prev. Sanitation Permit# °----------------'-` '- Date==- -y-v~ i F_ ------------ 3 r;r _ Septic Tank (Specify Requirements) ----------------- --- ----------------------------------: ------------------------------------------------------ - Disposal Field (Specify Requirements) --------------------------- y : ------------ ----------------------------------------------------------- ---------------------------------------- ---------------------------=------------------------ --------------------------------------------------------------------------------------------------------------------- _ {Draw existing and required addition on reverse sidey ,� - I hereby certify that 1 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. Horne 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 become subject to Workman's Compensation laws of California." Signed iliation_, z�C------------------------ Owner 'resident Title --- ------------------------- ---•----- ----------- • ----------------------------- ----------- ----------------------------- By (If of er t an owne FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' '"`'------------ - ----- ------------------------ ------------------------------------. DATE -_- ----------------------- ----------- BUILDING PERMIT ISSUED --------•----------------- --------i--------------DATE ------------------------------------------- ADDITIONAL COMMENTS _. --•----- ------------ -------- ----------- ---------- - -------------------=--------•-------- ----- 01-------- ------------------ --------------------------------------------------------------------- --------------- ------------- -------------------- ------------- Date ' 7 Final Inspection b SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M,