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- F_9R OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------- - � Q ^,\ (Complete in Triplicate) Permit No. - � r ---- ---------- ------------ Date Issued .. �-�_'�� --------------------------------------------------------- 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 complia ce with County Ordinance No. 549 and existing Rules and Regulations: 410 JOB ADDRESS/LOCATION 400.-_.l________ _ ________________CENSUS TRACT -------------- ........... ------ --------- - ` Owner's Name R N®_L. r�..� -�QT-----�`j-�------------------------------I-------------------Phone------------------------------------ Address -923 - 2633; --- - - - Address _23900-A- -----[�_f R_Pa T-------t_AJ__A__y-------------------- City __Mp9_/AJJ�,-C/4-------- --- ------•-----------------••------ Contractor's Name ----- E e A R G l e - License # �-"�!-_3''7/_ _ Phone .t?_2 3— C-Ta Installation will serve: Residence [g Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:---- .----- Number of bedrooms --- ----Garbage Grinder ------------ Lot Size __AC(ZtII_4:-____-------_ Water Supply: Public System and name --------------------------------------------------------------------------------------------------•------------Private Character of soil to a depth of 3 feet: Sand';C Silt❑ Clay ❑ Peat F-1SandyLoam ❑ Clay Loam;❑ Hardpan [-] Adobe E] Fill Material ------------ If yes,type _______-___-_______--__ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit ermitted if public sew r is available within 200 feet,) N PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size------------------_---- -________-________-__ Liquid Depth ______---.--._______ ... k" Capacity Type Material No. Compartments - .� Distance to nearest: Well ------------------------------------F undation ---------------------- Prop. Line _.._______:__________. LEACHING LINE [ ] No. of Lines _ Length of each line __________________________ Total Length ..____.____ ................ 'D' Box ____________ Type Filter Material __________________ _Depth Filter Material .__-___________.__.._-__-.__..__-_-.__._-_ Distance to nearest: Well - -- ------------------ Found'tion -------- --------------- Property Line -------_----------_-- SEEPAGE -_•_______________ ___SEEPAGE PIT [ ] Depth ----------- -------- Dia eter ________________ Nu er ---------------------------- Rock Filled Yes ❑ No 0 Water Table Depth ------------------------------------------------Rock Size -------------------------------- V Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .._..__....._ ........ . REPAIR/ADDITION(Prev. Sanitation Permit# _________________________ ,r________..--__ Das .---------------------------------) -10 ri Septic Tank (Specify Requirements) _____________________________-___1® ��k 7 Disposal Field (Specify Requirements) ---p!DO -- --- -------------l�t_4_Tee- -(3e0 0 N. �_N�D OF 60,571IV i* L-_l4le ----------------------------------------=--------- -------------- 'E ------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------- (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 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 lows of California." Signed -- 1 ; - Owner = Title- BY -------------- ---------- ------------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ------------------------------------------------------------------- ------ DATE ----V-7- ©' ---------------- BUILDING PERMIT ISSUED - ---------------------------------DATE --------------------------- ADDITIONALCOMMENTS ----------------------•-------------------------------------------------------------------------------------------------------------- ------ .•_. ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------ -- ------ - -t-e-,ILt----=------. ---------------------------------------------- - - ----------- - - ---- -------------------------- Final Inspection by: -- ------- -- - -- -------------------------- -----------•------ -------Date --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M