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71 FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT �0 5zo ----------------------------------------------------- Permit No. - (Complete in Triplicate) ----- - -- - 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''na'lication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOBrADDRESS/LOCATION .------------�� 1p ___----------------- ------- 1 r---CENSUS TRACTp__�-"--s--•--•--- Owner's Name ----- .1-I L- - - hf: `t �G �_� �Q-+- •----------- -------Phone._9-59----VZ 4--�- Address ---- . .._ ----- ' --------------•--. City ___ ®-------------------------------------------------- Contractor's Name --- HIL:-1-k f�-�"------CO� -0---4,-----=-----------License# -------------- Installation will serve. Residence �artment House-[] Commercial ❑Trailer Court E❑ E Motel ❑Other -------------------------------------------- i ` Number of living units:---I------- Number of bedrooms _3------Garbage Grinder 1V- Lot Size _949--_--X__/qa--------------- Water Supply: Public System and name -------IATH_ROP-___---Cf_T/V _UV'fq 7`F___K---------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat Sandy Loam lay Loam;❑ I _ i 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 seeps pit permitted if public sewer is available within 200 feet,) O PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size_______ _ _ X3-----_ q p p �J'� -- - Liquid Depth . �---Z�----- Capacity _ Q 0---- Type -` _ Material_0/43FTF—No. Compartments - spa"' :�t, r i ,�__ Distance to nearest: Well •-,___6_4—I ------- --- � _ ---�..� ---------- - --------- � ---- .' - - _-- Founds#ion _�� -------- - Prop. Line _-- -""-- - LEACHING LINE f No. of Lines --- __2--------,_____ Length of each line---/. __-�____._.____ Total Length -------.- I *D'Bnx jT�gpe Filter Mater:ial� - _.d3epth.Filter-..Materiaf i--j f1.�y----------- ...... --- 4 ' Distance to nearest: Well �`______ _____ Foundation /G1___ ------- Property Lines SEEPA E PIT [. = Depth -------------------- Diameter __________--- Number ---_:---------------------- Rock Filled Yes '0 No 1❑ # r Table Depth ------------------------------------------------Ro k�Size -------------------------------- Distance --------------•- ------ � W a to e p Fr,, � I Distance to nearest: Well --------------------------------- ------Foundation -------------------- Prop. Line ---------'--.......... FJ k } I REPAIR/ADD4'I•!ON(Prev. Sanitation Permit# ----------------------------------------=--- Dater--=----------------------------) , Septic TanV(Specify Requirements) --------------FSS------90--------L1f�- -- ------a .I ------------ Disposal Field: (Specify Requirements} -------------------------------==•=--t =---------------------------------------------- �'-------- •----------- I .---- ------ ------__.. - ;__ -----_--._-� - --------------- i I ) x - eo = --------------- f:"- ----------- -------- - - a---- '---------- (Draw f e .. 1 i it (Draw existing and requir-ed addition on,,reverse side) r� I hereby certify!_fhat I have prepared this application and--th'af' the .3woYk';will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen- sed agents signature certifies the following: � s' "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 Wo man's Compensa ic. laws of California." " s: Signed ------ --"---- ------- Owner t f By ---------------------------------- ------- ---------'=--------------- --------------------------------- Title --------------- ------ ---------- --------- ------- i { (If other than owner) _o F FOR -DEPARTMENT USE ONLY APPLI ;ATION ACCEPTED BY )-- ---_-DSS nE __-- DATE _.---_ .__"-21--�--7 ------ q. _ __ _. _ _-1... _. : �_w__�. .._ _ _ _ ADDITIONAL COMMENTS - f ``'- f) = -----------------------------DATE -- ---------------, - .-..�-+v-��-.r 4 --- i --- - _ -_-_-_:_----- ----------- - - -- ------- --------------------------------------------- ----- ---- - ------------------ ----- ------------------- ---- -- -- : r-- $F �Final Inspection r -Date ---- � - SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M