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FOR OFFICE USE: APPLICATfqN�FOR SANITATION PERMIT __ ------------- - ------- - Permit No: --------------- •-•-• (Complete in Triplicate) This Permit Expires ] Year From Date Issued 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: -tzJOB ADDRESS/LOCATION � lre $ z� ¢'17�---- CENSUS-TRACT ---5-"`�-------- Owner's Name ------------:P/2L Q---:----- ---- - ---------------- -------Phone Address --------P, �?t--- Q-'7`�---------=----1?-?---b------------------ City --- z)z><<= 27e------------------------------ ---------- ------ _ Contractor's Name -----��_�_�_._.�1,�'��-�/�--------------------------------------License # �� Phone Installation will serve: Residence ❑ Apartment House[] Commercial;❑Trailer Court [1 Motel ❑-Other ---- ------------------------------------•-- F Number of living units:___]__ Number of;-bedrooms :__..Garbage Grinder ------------ Lot Size -- - : _ . Water Supply: Public System and name -------- r_ Private i Character of soil to a depth of 3 feet: Sand'❑ -Silt❑ Clay ❑ Peat❑ Sandy Loam ❑Clay Loom'[]__.. Hardpan Adobe'❑ Fill Material ------------ If yes, type -----.------- ________-- (Plot plan, showing size of lot, location of system in relation torwells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or. seep pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT { ] SEPTIC TANK"[•� LL=. Size____-6.X�X-- !'_'4Z_-____.______ Liquid Depth ---- - -----------•- r Capacity_ _ Type rL_i��Sy ,al---------------------- No. Compartments ---- . Materi _ ..:.... tarice to neare�Well _----- 0 - --------- -_-Foundation __._� C______-_- -_ Prop. Line ----`�-=----------- tLEACHING LINE ,,SNDios. of lines _-_:_ __.__ Length of each line------ t---� --- Total Total Length ` Eat / �./ D' Box _ _ '_ . ._ T e-Eilter Material Xd _De th Filter Material _____ i { — J Distance ___ ____FounaionT_ l�_1-_--_-______-Proper-fir Line ______ ____ _ _____ __ �1 a SEEPAGE PIT Depth __ __ Diameter -•_--- Number ---------------- Rock Fill: cl, Yes Er" No i❑ ". Water Table Depth --------- ---- -----------------------------Rock Size _2 _X_v2 ..__ 1 �� Distance to nearest: Well ------sfd ________________________Foundation _-_/ __________: Prop:,'Line .......................i'4 REPAIR/ADDITION(Prev. Sanitation Permit# ---_-----------------_r---------------------- Date ____-_--_______________________--_j Septic Tank (Specify Requirements) ----- ------------1-----------------------.1--- - -- _ ---------------------------- Disposal - ---------------Dis osal Field (Specify Requirements) ` [ -------------------------------- _, ----------- - ---------------------------- --------------------------------- = - ----------------- t -�------------------------------ ------------- ---------------------------- - --- — - �- �� [Draw eXisting and required additi6n=onrreverse-s�dej� I hereby certify that-) 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 signatuie 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 t as:.to become subjeco Workman's Compensation laws of California.," # Signed - ' XX ---- -------------------------------------------------- Owner rBY -------------- -------- ----------------.---------------------- ------ Title .--------------------------- (If other than owner) ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y --- t - ------------------------------------ DATE - 12—.'-3 73-------------- r BUILDING PERMIT ISSUED ---------------------------------------------------------------------- -------------------------- ---------DATE ------- ----------------------------------- ADDITIONALCOMMENTS ----------------`--------------------------------------------------------------------- ---------------- -------------------=------=------------------------- ------------------------------- - -------•----------------------- fi 6s -- - ` ------------ - - � S- J--" - ------------------- -Final Inspec --- - ----- -------------- ----- ----------------------.Date _....----- ---- SAN JOAQUIN LOCAL HEALTH DISTR,.trT - E. H. 9 1-'68 Rev. 5M -" -