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FOR OFFICE USE: -„` . APPLICATION FOR SANITATION PERMIT Permit No. ----- --- -� 9 5 (Complete in Triplicate) _____________ This Permit Expires i Year From Date Issued Date Issued Application is hereby,made t6'the San Joaquin Local Health District for a permit to construct and install the work herein described. fhis-appl.icarior�is made in compliance with County Ordinance NO'. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION-f --/3559,7,7�,.�__p Qm --- �'- P 4-5't--------------------CENSUS TRACT ------&--------------- Owner's Name L�-' --�o`-'"1-a-------------------------------- Phone : ' - �- . Address ' Q � %� f. City - 'Qr 1'1 --------------------------------------- Contractor's Name --------&,--(7_ - - �$ y License # Phone Installation will-serve. ,w--- Residence RA�epartment House�❑ Commercial :❑Trailer Court ❑ Motel ❑ Other ---- ---------------------------------------pR Number of living units:--- -/----- Number of bedrooms ----IGarbage Grinder fw(9---- Lot Size ------`` ---- Water Supply: Public System and name ---------------------------------•- --------------------------------------------------------------------------Private [� Character of soil to a depth of 3 feet: Sand'❑ Silt.E] ay ❑ Peat❑ Sandy Loam Clay Loam -❑ Hardpan ❑ ;Adobe,❑-' Fill Material=-V( +If yes, type----_____-__----_-_- (Plot plan, showing size of lot, to ation_of_system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) {� PACKAGE TREATMENT [ ] SEPTIC TANK'[ f Size-----------L-1---------------Y_--_--- --- Liquid Depth --------------------------- Capacify -'--------------- IyPe~ -------------- - Material No. Compartments ----------------- y ill Distance to nearest: Well -- _---------------Foundation --- ------------------ ----_ Prop. Line _---------- ------ LEACHING LINE [ �-1 _No! of Lines -------- Length of each line--------- ------------- Total Length 'D' Box ------------ Type Filter Material --------------------Depth Filter Material+ -------------------------------------- _ .� - --------`Property Line --i��. Distance to �earest: Well -------_--,_.- - ---- ---.w Foundation -------------- ------------------------ SEEPAGE PIT [J Y Depth -------------------- Diameter -------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ---------------------------------------=--------Rock Size -------------------------------- Distance to nearest:-Well __------------------------------------Foundation --------------- Prop. Line --------_-_---_----_-- REPAIR/ADDITION(Prev. Sanitation.Permit# ------------------------------------------- Date ---___-_---_---------_-----------) .e...Septic -.(Speci4y Requirements),-----;� ---_: -- =:_- :_ _------------------------- -Tank — Disposal Field (specify Requirements) ------------ ------- ---- ---¢--" ' r - --• ff,~ ------------Dt6T------a-qx----------��- ----- 'L��3 =�,arL[:I�E� "�—: ;�R, :K '�5 ��T�C� �j"�------- g q jr --------------- - (Draw existing and required-addition-on---,�----------------------------------------- ----- --------------------------- ---------------------------- - --------- - . _. d ition-on reverse-side)---- T.. -- p- - --- 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- "] certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner i' as to become subject to Workman's Compensation laws of Citlifornia." P / Signed --- ------ -- -------- !------------ Owner By ------ --�G�� == r {�� Title ' ------- ------------- (If of r han owner) FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY -.- --------------------------------------- -- -------- ------------------------- DATE ------------7---1'!--116 ----------- BUILDING PERMIT ISSUED ---------------------------------------------------------------------------------- -----------------------DATE ------------------------------------------- ADDITIONALCOMMENTS -- - --------------------------- - ---------------------------- - ----------- ----------------------------------------------------------------- ----------------- -------------------�-- ----------------------- - ------ -- -----------__---- ---------------- --- -------------------------------------- ----------- ------------- _-.- -- -- -- -- --------- -- -------- ------- ---- --- ---- --- Final Inspection y- ----- ----- ---- --- - Date 1 SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M