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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT E ; (Complete in Triplicate) Permit No. __7 _l0__&.. --------------------------------------------------------- r ___--_-__._______________________ 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 complia ce t unt 3rd' ante N 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION..--:----onSu .enfield--R-_-,__ af-_:.-Co_ll er__R-------------CENSUS TRACT `"�.�.---.•----____-- f Owner's Name ------Char_les-_Da_v1s___-_---- uild >'_�._-Nero_1�1 �IiIi1_Ii ms--------------Phone Address ---705-- "Gri', Street�_._G_altx a -----------• -- city Gantractor's Name ------------License # _181'784------- Phone __ 8 --8. 71------- Installation will serve: Residence ®Apartment House[] Commercial ❑Trailer Court ;❑ Motel ❑ Other-------------------------- Number ------------Number of living units:__X__�_ Number of bedrooms --;.__.___ -- Garbage Grinder --- ....... Lot Siie------ 4cre-S....... ------------- Water Supply: Public System and name ----------- ---------.------------------ ---- -_ _ _ Private ------------ Character of soil to a depth of 3 feet: Sand❑ Silt o Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Al i Hardpan Adobe:❑ Fill Material_:%-----.:-- If yes,tyPp. _ _-_I-I-'----------- -- N =• , JPiot 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-----l2_pQ..g�11D_ri---------------- Liquid Depth -___-____________....._... .Capacity 1.5"NZa1_ Type -------------------- Material__ggWn Tete No. Compartments -----_ __: Distance to nearest: Well __-- --------------------------Foundation ---------------------- Prop. Line ...............---_-- ` LEACHING LINE •] No. of Linies 2-_-----______ Length o a line.____!QQ-LF----_-_-- Total Length _..__MU--- LL_ 'D' Box ._1.______ Type Filter Materia _ ____ __ _____ _Depth Filter MaterialJ-9............................. . . I: --------------- ' Distance to nearest: Well ____.__�0.1_________ Foundation -A-S __ Property Line. � _ SEEPAGE PIT Depth -----;25_]------- Diameter ______-3QT__ Number ----_2___________________ Rock Filled Yes ( No i0 Water Tab ------_ _ le Depth _ - ---------- ------------------•-_..Rock Size --- ------ fi __-- _ - Distance to nearest: Well ----ZG0_i_____________________,....Foundation sSY�J__ i _�-�_______ Prop. LineCl__.,J � ____ __...._....._.. t ) REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date _____..___.._ ___________._....._ i i Septic Tank (Specify Requirements) -_ ---------------—--------------------------------------------------- - :-_------------------------- DisposalField (Specify Requirements) ----------------------••-•--•--------------------------------------------------------------------------------------- •------------•-- ----------------------- ------------------------------ ----------------------- ----------------------------------------------------------------------------------------------------------------- JDrow -------------------------------------------------------------------------------------------------------------- {Drow existing and required addition on reverse side) y 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, aril Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- a 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." t Signed I- "r n- tton; -1-n-c- ------ -------------- Owner BYTitler e -en t-------------------------•---------- (! t�he h o i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -------------- -- DATE BUILDINGPERMIT ISSUED -------------I------------ ---------------------------------- ---------------------------------------------DATE ---------------------•-- ---•-------------- ADDITIONAL COMMENTS ---- ------ 1 F ----------------------- --- ------ -------------------------------------------- - - - ---- ------------------------------- ------------ --- -- ------------ - Final Inspection by: -- ---------------------------------------------------------- __Date��:1•l- 1_- r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M•