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FUR-OFFICE USE: APPLfCATION FOR SANITATION PERMIT---------I...................... -••-------- �� {Complete In Triplicated Permit No. _.7._.7_._...__...__.. .....................................I.................... _ ._._ .. r This Permit Expires t Year from Date Issued Date issued . `..7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described T i licatio ode in m liance with Count Ordinance No. 549 and existing Rules and Regulations. �S�pp� �%d� ��° y q��".)?4,--CENSLIS JOB DRESS/LOCATION ;/�IY1 . � + L `�j'�erlTl' TRACT .�4. '.Qk.�............ r Owner's Name .M.(1 -...... -r-e.m.........................................,.....................................Phone .7��7 Address 77.y_. 41S .A..... AA,,...... ............ City ...... -E C_ -f.VAJ... ................. C' S' Contractor's Name .._--_ �1F+�-�_-:�,40h � -. ..R.........................License # �'..J.7s /....... Phone ................3 ' ' S'3.?� .. Installation will serve: Residence MApartment House C] Commercial❑Tra€ler Court Motel ❑Other ..._..._..................................... Number of living units:-------- ... Number of !bedrooms .,.......Garbage Grinder ............ Lot Size .....l l<c.a 5.................. Water Supply: Public System and name --••..............................................•---.........................................................Private 1 r Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam E31" Clay Loam ❑ 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 f ] SEPTIC TANK for- Size.. �._X..S�.!-•-- �� Ldo'-- -•-•-- .... Liquid Depth •---J��-....--- r Capacity,147qo;F49/_-Type .. -i Material.. li` �G,. No. Compartments .... ......�..... Distance.to nearest: Well .--1................................Foundation J.9).............. Prop. Line ...1.� ....... . D LEACHING LINE; [W No. of Lines .3----------------- Length of each line----- ............... Total Length ../ ............. 'D' Box . _4-- Type Filter Material Depth Flite-r Material ...3...�.... TI1 Distance to nearest; Well __ dG r_...... Foundationrl-..---. c>�c.�.............. Property Line - . . SEEPAGE PIT [,4- Depth _a.5 .......... Diameter ..13`r_... Number .....3................... Rock Filled Yes ffl- No O 0 Water Table Depth ----------------- .......................Rock Size ._ I!Zz� .. r Distance to nearest:-Well __-f��------•.........----------Foundation . Prop. Line ...�r�............ ,1 REPAIR/ADDITION(Prey. Sanitation Permit# .........__-'..__._._.--•..............:.... Date.............. ...................... ) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) .........................-----------------------------------------------------------................._.0 ----•----- ----•-----• --------------------- F •......... ............................- ........... .................................................... •-------------------------- ........... ---•----- --------- ---------------------------------------------------11.-111--1..................I............ JDraw -- --- {Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with Son 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed - ----- - ---- ------------------------------------------- .--------- Owner BY ..............•----------------.---------------- Title _. .....�� If other than owner) FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY --- -- --• --•-•--- --------•------- --•---- DATE .1.._ ------------------------ BUILDING PERMIT ISSUED ------------ -------------------------------------------------------- -.:._ -•--- - -----DATE: .......................................... ADDITIONAL COMMENTS ....... . . .........••-----....... .................. -----•-------- ----------- -------------------------- ---------•- ---------------------------------------------- -1- -----•-- --.......................I----- •........._. ----------- ............ final Inspection by: .._....... .............C•'•- -------- -•.................................._.:-•.._...._......._...--•-•-.• ....Date _..� 31��..... 2 1-68 ftev• SAN JOAQUIN LOCAL HEALTH DIRECT 8/7h 3M