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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,_......................... Permit No. .7s..:3_:5. � w (Complete in Triplicate) �`j Date issued .....�....:. -v----- This Permit Expires I Year From Date Issued Application'.is hereby made to the San Joaquin Local Health District for a per to,.construct and install the work herein described. This application is made in compliance with.County Ordinance No. 544 and existing Rules and Regulations: 1616 Berkley., _ JOBADDRESS/LOCATION ..........--•---------.............•. ........................................_--------_...:_...-- ........CENSUS' TRACT. .,•......:._...._..,._.... Owner's Name ....Nr-•. •Jo-seph--D&1-ue-ah --------- ................... .. . ....................................Phone......-.._.. ......... 1616 B- rkl Address ..:.................: .... -- QY:......'::.:.........'_:. ;....:: City .......... ttac Jy© ::.. - Coritractor's Name . . Roto .,Rooter 'Ser'. License #271539 Phone- X65-26]6 ....._._...._.... .................................................. _ --- Installation will serve: Residence ❑Apartment House 0 Commercial❑Trailer Court, Motel❑Other ._._.......:....... _ Number o •1 f living. units:'__...____. Number of bedtooms .........'...Garbage Grinder:eS...._. Lot Size X0-- by 7 Water Supply: Public System and name'--------• Gal ; ter Sem:-----.......-•---......-•-------- •----•----......Private C] Character of soil to a depth of 3 feet: Sand❑.xd:Silt.❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe;[] Fill Material z.......... If yes,type .....................:....... (Plot plan, sl+owing%s'ize of'I( t locotion 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 TREA,TMENT ( ] SEPTIC TANK .................... Liquid Depth 2} ............ ...._ •-} 129 pre "cast con_crete �• martmen s .Capacity = Type Material.__.... _ ___ 14,6p 6 Distance to nearest: Well _Foundation`'...._....___.._ Prop: line:.. . .._. is . 6 ! LEACHING LINE [xJ No. of Lines'_!................... Length of each Length 'D' Box no . Type Filter MPt�eriai ..,-ro rock. Depth �ite� Material 18" r .... _._... •--•---•------------ i......... Distance to nearest:.Well ______________•__--_._-_ Foundation ......................... Property Line -----I................... ]` I SEEPAGE PIT r [ Depth 25_f......:...... Diameter �8!t_........ Number -1.-------.:--Z�------ Rock Filled Yes-13 No ❑ . 781 i rr �o r I Water Table De th Rock Size .Y..3_..._..._.. r Distance to nearest. Well r p y Foundation f_-__l...r_ _.... Pro Line .................... REPAIR/ADDITION(Prev. Sanitation Permit r# .....:.......... ................... Date .. .. ........ ' Sepfic Tank{Specify Requirements} ...:......:. ------------- ------• ........:.................................................----------- -------- ----- Disposal Field (Specify Requirements) ..........o1d- VdYff-ViI1- _5_& 11:1ed-only pons bXe sy em ....................I----------------- ---------.._ ......... •----- -•-•---------die=--�©...ht•-•s-�-�e---�-a �------------------•--- - -..- -------------------------- f_-... ....._..----•..-----------------.-._-.-_.._----------- - ---------.................................. ----------------------------------....................... _.(Draw existing and required addition on reverse side) 1 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-signatu"re certifies the following: "1 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 becomeA� l ' t to Workman's Compensation laws of California." Signed --=------ - -• :.. ---.. '...........-------------•-•••. Owner By................ _ :.............. Title ....__._....._. . n r than owner} JO R D ARTMENT USE ONLY APPLIC ION ACCEPTED BY.... .... ............=----------------------............................. DATE .:.5: ................ BUILDING PERMIT ISSUED = DATE ADDITIONAL COMMENTS-- - • _.:.C....................................... .:.../ _.G? "...........:. ,.................................. i .. • S l _ °........ .. ................................................................................. . ...........•........................ _...__•----------------------- - ........................... .... .......- . ...._---•• - .......__._...._. .---•--........... --• •_•___............................................ .............. _______________________ ` ... Final Inspection by �. r_�L ate ................ SAN .JOAQUIN LOCAL HEALTH DISTRICT E_ H. 13 24 1.'68 Rev. SM 7 72 3-24 _ -