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FOR OFFICE USE. "3a APPLICATION FOR SANITATION PERMIT 7f�-- 11------------------- Permit No. -(Complete in Triplicate) ---------- - ------------------- - -.-3 01 This Permit Expires 1 Year From Date Issued Date Issued - -f/ 71 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 Count Ordinance No. 549 and existing Rules and Regulations: � JOB ADDRESS/LOCATION ��__�.--- ,F- ----- �-------------------CENSUS TRACT -------------------------- Owner's Name /!.-4�-0._ Y�rA----- ---d l�-ROWN------------ --- ----------------Phone 4&.,�_j.s_.S>_7------- Address ----------ZG-0--------- $A_-IV-------- City ------------------------------ Contractor's Name --------------------Pfd--9--P,1-5-H-----I SOWS-------;.License #,/00-67/1------- Phon4AA/Q_Fb0_7.--••----- Installation will serve. ResidenceKApartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number -------------------------------- ------Number of living units; 0_-)_ Number of bedrooms-s-�_-GarbageGri er Lot Size f ----------- --- -- _- Water Supply: Public System and name ---------Q,101- --_-- :- - Z,.r--------------------------------------Private ❑ 4 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ IPeat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ :jAdobe.lk, Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, 3etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is a oilable within 200 feet,} PACKAGE TREATMENT [ ] :.SEPTIC TANK'[.]_.._...,,,,Size --- --------------------- ------------I Liquid Depth CaCapacity r O P Y -----------------'- Type -------------------- Material-- -- ------ - Na. Compartments ------•-----------•---� i .D stance to nearest Well ----------------------------------1-Foundation ----------------.----- Prop. Line ---_---------:---___-- f h Fn LEACHING LINE [ ] No. of Linesw�___t._____1________ Length of each line_ ________________fi--------__ Total Length V -------------------------- D' Box . _,�r'.-=,°Type Filter Material ------- ---.Depth Filter Material -------------------------------------------- l Distance to nearest: Well ------------------------ Foundation .____.___ ------------- Property Line __.__..__----_--_---. SEEPAGE PIT [ ] Depth ----------------- Diameter ---------------- Number -------------------- ______+ Rock Filled Yes ❑ No I❑ Water Table Depth --- --------------------------------- ------Rock Size -------------------------------- Distance to nearest:.Well _ ____________________________ ______Foundation -_ ______I---.---- Prop. Line __________---_....__.. i REPAIR/ADDITION(Prev. Sanitation Permit# -.____ -____�_ ___�_l_____________ __ ___Date,________-•_____I______=__________) l y r Septic Tank [Specify Requirements) ------- - _- w.�- ------- - - -- - ! -_�--- ----- �--- --_'-�----- Disposal Field (Specify Requirements) --- -- --_+ °--- - - -- -- ---- - ----- --_---- + -- _- ---------------------------------------------- ----- ) Ire ------------------------------------------------------ ----- (Draw existing and required cidd4ion 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 fjoaquin local Health District. Home owner or lion— - sed agents signature certifies the following:' ) 3 t ! "1 certify that in the performa a of the wok for which this permit'is'is sued, I shall not employ any person in such manner as to beco a b)ect to Work' n's Cc pensti laws of California." Signed ------ - - - x Owner BYyam. _ _�__�_----- ------ `----- -- -----,-- --- Title `---------------------- ------------------------ ' (If other t an owner) Pa FOR DEPARTMENT USE ONLY ; APPLICATION ACCEPTED BY DATE �f+ ~ 7/----- -------------- BUILDINGPERMIT ISSUED ------------------------------------ --------------------------------------------------- --------------DATE__-------------------------------------- i ADDITIONAL COMMENTS ------------------------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------- --------------------------- --------- - ------- --- --------- --- - - - - - - - ---- - -- -- - - - - - ----- - -- -- - -------------------- --------- ---- -- ---- ---- ---- --- - ---- Final Inspection by: --------------------------------- -------------------Date f ' 1 SAN JOAQU}hi LOCAL HEALTH DISTRICT w E. H. 9 1-'68 Rev. 5M