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FOR OFFICE USE: aT APPLICATION fOR. SANITATION PERMIT --------------------------------------- Permit No. ---------- �-° (Complete;in Triplicate) r _.--._._.'-------- Date Issued ----el- Z . -------- ------ - This Permit Expires 1 Year From Date Issued /�7f 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. M .�� JOB ADDRESS/LOCATION .-- __ -- -- --1.�t-------RX S'�!-------------------------------------CENSUS TRACT ----------------_-------- Owner's Name _�_ ----- 1 -•-----------:----------------- -------------------Phone -� 0�7iq-�-1477 Address -------I Ali-------- G4 1'-;Z-----------/� � ------------------------------- City S;70.e—woJ--------------------------------------------•------- Contractor's Name -----T4,&.k---C4, ---License # 2�WY .... Phone _y '3'78 _ Installation will serve: Residence EApartment House❑ Commercial❑Trailer Court ❑ Motel ❑Other -------------------------------------------- p y I Number of living units:_ ____._ Number of bedrooms ___ __..Garbage Grinder . D_- Lot Size _-/_(® I _________Private Water Supply: Public System and name -----Pu6`J[r--------------------- 1-------------------------------------------111111 11-1111-- ❑ Character of soil to a depth of 3 feet: Sand'[:] Silt❑ Clay .❑ Peat❑ Sandy Loam .g3`0"Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ____________________________ r (Plot plan, showing size of lot, location of system in relation to- wells, buildings, etc. must be placed on reverse side.) N NEW INSTALLATION: (No septic tank or seepa a pit permitted if public sewer is available within 200 feet,) /V PACKAGE TREATMENT [ I SEPTIC TANK Size___ :f' '1 -r------------------ Liquid Depth ____ ------------ Capacity _J-200 --- Type ----------- Material__ecNE1P�:�o. Compartments ----- ---------- ((�� F f � Distance to nearest: Well _____�c»I/�_________--------Foundation ---f0___----------- Prop. Line :.,____._ s LEACHING LINE VA,- No. of Lines ----2— ':line ---___ Length of each `line_____-9�________________ Total Length ---IA?------------__ 'D' Box ---/------ Type Filter Material _z____ at .Depth Filter Material ______/?________________________________ l f Distance to nearest: Well --41a,V_Er____-- Foundation -------------- Property Line ___4'f_~_______________ SEEPAGE PIT [ ] Depth -------------------- Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No ❑ Water Table Depth ------------------------------------------------Rock Size ------- ------------------------ Distanc- to nearest: Well ________________________________________Foundation --------- ---------- Prop. Line ----------- .......... REPAIR/ADDITION(Prev. Sanitation Permit -------________ _____________________ __ __ Date # ---------------------------------- .y� ) Septic Tank (Specify Requirements) ---------------- /{ t. --- ------------------------'---------------- 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 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 become subject to Workman'spensation laws of California." Signed --- ----------------------------------------- O BY -------------------------------------------------- --- ------------------------------------------------ Title ------------------------------ ---------- ---------------- -- -1111-- - (If other than owner) FOR DEPARTMENT USE ONLY ACCEPTED BY DATE ------------ APPLICATION 71----- -------------- --------1111-- BUILDING PERMIT ISSUED ---- -----------------------------DATE =-_-_--•--------- ------------------- ADDITIONAL COMMENTS ------------------------------------------------- -- ------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- -- -- ------------------------------------------------------------------------------------- -------- --- - A---' _- -` ��-vim'---------------- --- Final Inspection by: ---------'-----------------111111 11-1111-- --- ------------�---------------1111-- 1111- - .Date �----1111-- l - -�---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M