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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------------------------------------------- 7_176-3--j? (Complete in Triplicate) Permit No. I ---------- ti----------------------------------------- -___-- -- ,; This Permit Expires 1 Year From Date Issued 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J` 1_6_3 - - AAtt JOB ADDRESS✓LOCATIOON--11_-1.6.3------5_NI8--------LANE----------S-TI�ENSUS TRACT --------------I........... Owner's Name 61 _'l_-----MCKE R---- ------------------------ . ---------Phone - --- q ! i3Z Address -d. - �/ �� ------ city . ��/� ---------•-------- Contractor's Name - ----------------------- ------•-=-------.License # ------------------------ Phone --------------------- Installation will serve: Residence"4Apartment House❑ Commercial []Trailer Court l❑ Motel ❑ Other - ------------------------------------------ � / t Number of living units-----I------- Number of bedrooms "?-_____Garbage Grinder ._/S/ Lot Size -- --1_r o_____________ Water Supply: Public System and name --fdd - ----------------------------------------------------------- Private E] ) Character of soil to a depth of$ feet: S ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ \ Hardpan E] AdobeFill Material ------------ If yes,type ________ _______ T F (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) v NEW INSTALLATION: (No septic tank or'.seepage pit permitted if pu Iii sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK,D4 Size-__ x � ------------------------ Liquid Depth _J---2--------------- Capacity ___.._- -___ Capacity 1200-------- Type ------------ - ---- aterial_&� No. Compartments ------•--.- r f Distance to nearest. Well _ _________________Foundation _ 1b--_____________ Prop. Line _�_____r__________ M LEACHING LINE No, of Lines S------------------- Length of each line- _-1_o ---_____-_____ Total Length "Q-?0._------.---. 1.u tt " 'D' Box Type Filter Material I-� -___ _______ epth Filter Material _ _ _._________________________________ If Distance o nearest:.Well '(l�iSO-------- Foundation 4AA��--------- Property Line R --------- 1 SEEPAGE PIT [ ] Depth ------ ___.___ ---- _.-Qiameter4 ' :_____________� _ _ _ Number ___ ___-_ __________-__ - Rock Filled Yes ❑ No 0 Water Table Depth --------------``-----------------------.--------Rock Size -------------------------- - Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ---------------------. S REPAIRJADDITION(Prev. Sanitation Permit# ----------=__----:_ ' ___ ate SepticTank (Specify Requirements) ----------------------° -----------------------------------------------------I------------------------ -------------------------------------------------------------- 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 San 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." - F Signed ---------------------------------------------------- Owner By X - ----------- -------- ---------------------- Title , ----------------------------------------------- - [lf other than owner) FOR DEPARTMENT USE NLY ' APPLICATION--ACCEPTED BY QN1i1 y �---------------------q-- . DATE __ 7 ---------------------- BUILDING PERMIT ISSUED ______ -DATE __.:___-.____ ------------------------ ADDITIONALfCOMMENTS --- ---------------------------•------------------------------------------------------------------------------------------------------------------------- ' t -----------------------'----------------------------------- ---------- ----------`-:-- -------------------------------------------------------------------- --- y ------ ------------------ - - -- - ----- -- -=- ---= - ---- Final inspectiota'by: - --- -- --------------------Date --- �- ------� i' -- ----- = r- SAN JOAQUI LOCAL HEALTH DISTRICT . E. H. 9 1-'68 Rev. 5M