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Vic.:' !t r414-0 FOR OFFICE USE: ra-`jq� APPLICATIO14 FOR SANITATION PERMIT �q U� {Complete in Triplicate} Permit No: _.73-4-iy --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued A--1-�-? 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: JOB ADDRESS/LOCA/TION __��__. .�-c� �2 --------- c/C7`o -----CENSUS TRACT ----------------•---•----- I Owner's Name 1144,o V---ATjf 7;�P _____.e&7 -. ------------------Phone Address 1 �c (elf ----------------•----------- City ea,C'f ]�6�L�_...... f1 ------------ Contractor's Name ._ / _J _ C" ___ r ---------License # Phone __ �*� -3_-frX4- Installation will serve: Residence E] Apartment House,[] Commercial frailer Court ;❑ Motel ❑ Other -------------------------------------------- ' Number of living units_____________ Number of bedrooms ______-___-Garbage Grinder ------------ Lot Size Water Supply: Public System and name --------------------------------------------------------------------------------------------------•------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam Clay Loam 1❑ Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ------_____________________ (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-__-____., x_ ---•__._______ Liquid Depth ----- -_ �--_______ Capacity _.[_1- ,O______ Type _W Material___C_c�r�CeZl�lo. Compartments -----�.�-:........ Distance to nearest: Well -----/490------------------Foundation _,�f�_ __________ Prop. Line ____ ......._..-- S' LEACHING LINE [ ] No. of Lines ----------_----------- Length of each line------- 5-0------------ Total length ------:57?P�............. V 'D' Box (.�-0__-_ Type Filter Material -�6FX-$r Depth Filter Material .____` -.------------------ Distance to nearest: Well _1490_1_____ Foundation ----14p�-------____ Property Line ____ ________________ V) SEEPAGE PIT [ ] Depth - --------- Diameter iff3_______ Number --------[ ________________ Rock Felled Yes 0-,--Ko o r Water Table Depth --________________________________Rock Size ------ Distance to nearest: Well ---- -- _______________Foundation —/0--- Prop. Line ..--- £]� REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date _-____..______.___________________) SepticTank (Specify Requirements) ------------------- ---------------------------------------------------------------------------•-----------._--1---------------------------- Disposal Field (Specify Requirements) ------------ ------------------------------------------------------------------•----- --------------------------------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that 1 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 i the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become su ect to o Co sation laws of California. Signedt - Owner BY ---------- -� Title than o r FOR .D PARj E ONLY APPLICATION ACCEPTED B ----- -------------------- DATE ---/0 -- j/ -23--------------- 'I BUILDING PERMIT ISSUED - - -DATE ---- ------ - - --------- ADDITIONAL COMMENTS �p - - 7� ---- ?A -------- W --------------------------------- --------------- ---- ----- --- ==- --------------- ---------------------------------------------------------------------------------------- ----- - ------------ --------- - ----- Final Inspection by�-- --- ------- ---- --- ---- --------- --- - --------------- -----------------------.Date -----Id/�� ` S----------- i i SAN JOAQUIN L CAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M G