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FOR OFPICE LSE: APPLICATION FOR SANITATION PERMIT - --- - y------------------------------------------ 1 (Complete in Triplicate) Permit No. _.__--��`%-. --------------------------------------------------------- , 4, Date Issued - -_ --�� --------------------- This Permit Expires f Year From Date Issued Application is hereby made to the San Joaquin Local Hblthbistrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: - JOB ADDRESS/LOCATION ___ ______-57KI _FF_--_---_-----IF -- -----------CENSUS TRACT - -------- Owner's Owner's Name ------ELM_E ��_Z._ 1F 1- '------------------------------- Phone t/, AddressCi A---- -------------------------------------------•------ Contractor's Name _1 VA_T_?R_F__Nf------ fill ---------- - --- - _ ---=--------License # 4��_A_7.7_� Phone -------------------------- 7 Installation will serve: Residence ❑ Apartment House(] Commercial ❑Trailer Court i❑ I Motel ❑. Other -------€------------------------------------ Number of living units-------[____ Number of,bedrooms _J____Garbage Grinder/%/AF,S- Lot Size - - R --_____________________ Water Supply: Public System and name ____ _________ __ Private �i ----------------------------------------------------------------- --- Character of soil to a depth of 3 feet: Sand'❑ .❑_{ (.Clay ❑ Peat E] Sandy Loam ❑ Clay Loam Rr Hardpan` Sil Adobe;'❑ Fill Material If yes, type -------------------------- =•. (Pl'ot 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 ublic sewer is available within 200 feet,) f �; PACKAGE TREATMENT [ ] SEPTIC TANK [ i; Size___ V_ ---�__--._---_ Liquid Depth -----7"-4-------------- i �'. Capacity --/2©Q,-- Type �Fba5T Material_(!0AJCT__-_ No. i ompartments _------ __. _111stance to nearest: Well ------__%-- ---------------------Foundation -----��---------- Prop. Line _-.,- ----------- 1 C LEACHING LINE (01' No. of Lines __ Leath of each line------D-L7..... r'Total Length ____�_70._�_.._._. 'D' Box ---------- T ae�Filterrllllater pI 19.0 C�___-Depth filter Materiai ________�__ ,.. , -----=----------- -------- Distance to nearest: Well ___ _:___247�_ Foundation` _-__-r0Property Line SEEPAGE PIT [ . Depth.,__./. ________- Diameter P( 92-Number________�Z_^_ Rock Fill d Yes �o 1'-' ------ �INater Table Depth - --- -Q-- =- Rock Size_-- -- :- Distance to nearest: Well ---- le�_GJ.-fir_____________x-= --Foundation.--«--�---------.Prop. Line ..�.--------___--- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ '-------------- ------ Date _______-_________-_.____.___.t�-)� Septic Tank (Specify/Requirements) ---------------------------- -`------:r]------------ ----------------------------------------------------------------- Disposal Field (Specify Requirements) _______________ l -------- _ ___ l __ r •� ------------ - �. -.----::-----:---- --- ;--.��------------------------- ---------------------------------.-�- �- (Draw existing and required addition on reverse side) — I hereby certify that I have prepared this application and tha€ the work will be done in accordanceJW'rth Sara Joaquin County Ordinances, State Laws, and Rules and Regulations of the'San Joaquin Local'Health Districcf,�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." l Signed '__._.._:_ -�iOwner ----- ----- ----- By --- - - Title (If other than owner) ' FOR DErARTMENTE� USE ONLY APPLICATION ACCEPTED BY x Q- ------ ----------------- ---------------------------------------- DATE ---- '- BUILDING _PERMIT ..ISSUED--- ----- ----- -- ---------------- DATE _.--:----- ADDITIONAL COMMENTS -- -- - - ---- -- ----------- - -------------------------------------- - -- - - - r"s }_. .i )r '------------ lj�'n� ,�. -------------------------------------- ----- --- ----------------== ----------------- - Final lnspectio --- - ----- ------------------- --------------------.Date ------------------- �i- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M