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- - V_- FOR OFFICE USE: XMLICATION FOR SANITATION' PERMIT -------------------- -- Permit No. __7_3T/__ . (Complete in Triplicate) } „ ----------------- -------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: , �7d _ i JOB ADDRESS/LOCATION ._ --------------_----------.--------CENSUS TRACT ____________ -------- -- ------ --- --- � -�-- -- - -------------Phone-----�_r7�_K._..: Owner's Name ------ -�-f- -- - ---- --- -- .; ----------------------- -- -•- -- AddresXd-156--e-ly - - - ---------- --- --------- ---- City ----- ----------- ------------------------------------------- # ------------ j--_-_-------------� -- # Phone Contractor's Name ...911 Installation will serve: Resident 18 partment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other -- ----------------------------------------- Number of living units:_--- .______ Number of bedrooms ___ ___Garbage Grinder ._.I ----- Lot Size b �" _________________ Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ------------ If yes, type ---------------------------- (Plot ________________-______(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 permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK [ ] Size--------------------------------------------- Liquid Depth --------------------------- Capacity _'v_-- Typekwerial---------------------- No. Compartments ------------• �> Distance to nearest: Welt' ____��----------------------Foundation __1z---------------- Prop. Line ----------_--:---.---. LEACHING LINE [ ] No. of Lines ----/ ----------------- Length of each line----/_A_a. .--- Total Length 'D' Box __1- ------ Type Filter Material 9__'�_3',_ Depth Filter Material ---1_7------------------------------------ Distance to nearest: Well ------------------------ Foundation -------------------Property Line ------------------ -SEEPAGE -_-_________-___-_SEEPAGE PIT [ ] 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 s# -------------------------------------------- Date --------------------- ............ Septic Tank (Specify Requirements) -------- JqA - ------ ------------------------ ,Disposal Field (Specify Requirements) __ _6_____ __ _ ,� !a___-.___ !"Z_v.___ -.-_--_ _ l\___1___JZ--______________ ------------------------ ------------- ---------------------------------------------------------- ---- ---- -------------------------------------------------------------- (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 r. 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." F t Signed --- --- - --- ----------------- ------------ - s ---------------------------Owner BY Title --- 1 rlfo� r than wner) FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY -_ -` QAT= l ----- BUILDING PERMIT ISSUED ------------':--- ----------------------------------------- -------DATE ------------ ---------------------- --- - ADDITIONALCOMMENTS --------------=----------- ----------- ---------------------------- ----------------------------------------ir-, w%---------------------'----------------------------------------- ------ y --------------------------------------- - -------------- - r -- 1_;-----.-: � .�. '2 ---------------------------------------- ----- - --------------' _ _________________•----------------------------------- -----------------------------------�/ f=inal Inspection by: ---- `-�� .y Date � �� _�-_ SAN JOAQUIN LOCAL HEALTH DISTRICT g d E. H. 9 1`66 Rev. 5M