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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- L-------------------- Permit No. 4� -7 (Complete in Triplicate) ----------------------- -------------------- Date Issued ___-a ___�_6__ - _ .6 ------------------------------------------------ -------- 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 pp p o 549 nd.existing Rul" and Regulations: described. This application is made compliance w� County Ordinance... + �� 40 JOB ADDRESS/LOCATITIONA6" ^- f`_ ��_04---_(� ,,�/ -r�l�f - --�----- SUS TRACT ---------,--a��... Owner's Name --- -T � ----rel �1� 1Y:-- -1-C1- r= '-_ -Phone - ----------------- Address � s �~ � City G� � C?= T_.. rJ Contractor's Name ----License — -5-54( Phone(?� _ ___� Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court ,❑ Number of living units:___-___-__ Number of bedrooms `r____Garbage Grinder ._ _.___ Lot Size Water Supply: Public System and name ---------------------------------- ------- --------------------------------------------------- ------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ = Adobe Fill Material If yes, type -- - Q,Es}�. (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 seeps spit permitted if public sewer is available within 200 feet,) # SEPTIC TANK Size--?-" __ x ------ Liquid Depth - _-_.__ PACKAGE TREATMENT [ [ -- -- q P ----------- Capacity240L?_____-___- Typef� '_�_-f _3____ MateriaO.17 M No. Compartments -------------_---- Distance ............. Distance to nearest: We11 __`__1�7 ----------------------Foundation _1d------------- Prop. Li _ / -_-_---: LEACHING LINE No. of lines ____ ____________ r [ Length offach line---(FO--------------- Total Length �------------------ D' Box�4V___ Type Filter Ma#eri j �-__-Depth Filts' Material l� t� ------------------------•---- 101 Distance to nearest: Well ------- Foundation / ________________ Property Line ------ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well________________________________________Foundation --------------------- Prop. Line -------.._.--..___---. REPAIR/ADDITION(Prev. Sanitation Permit# __---------------------;--;;- ______________ Date-------------------------------- SepticTank (Specify Requirements) -------- ----------------------------------------------------------------------------------------------------------------------------------- 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-566 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 laws of California." Signed -- ___-, _ Owner �-- B fX �� Title W�� - Y .. (If other than owner) FOR DEPARTMENT USE ONLY 77 APPLICATION ACCEPTED BY ----- ,-RAV-=--------------------------------------------------------------------------. DATE --- 0 —70BUILDING PERMIT ISSUED - •----------- ---------------------------DATE ADDITIONAL COMMENTS --------- LE145;' ----BEFE&----hP_P1.1G.,--�"_`__--------- _ -- - -----------------4_E�D�_ —TOW-A/s f.N�-r----------.�? 1�1J5 �. �f �i. ------------------ Final Ins - Date -----------"-�-- ------ ---- -- ---- ------------ a SAN JOAQUIN LOCAL HEALTH DISTRICT E H. 9 1-'68 Rev. 5M +'