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j rux upFFu Ube: APPLICATION FOR SANITATION PERMIT ` ' ............................................. (Complete In Trlplicate} Permit No. ...75Ljs;r' ` Date issue ��'7� ' This Permit Expires # Year From Date issued d Z" """' ' 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 mods In compliance with County Ordinance No. 549 and existing Rules and Regulatlonse JOB ADDRESSAOCATION . :,,(�.� ..�....... ........................CENSU5 TRACT ......................,... Owner's Name .Phone .................................... Address .....1� .. .., ..�..C� ... ..........................City xr.............. Contractor's Name Z",VdL. , .�...,�;�icense # et .`.�.j�.. Phone,, Vrx Installation will serve: Residence j Apartment House❑ Commercial❑Trailer Court ❑ Motel❑Other.........................g................. Number of living units:....Z.. Nlnber o$ roams -- --------Garbo o�lnder . lot Size1 ...�..... Water Supply: Public System and name _....._...........................................Private❑ Character of soil to a depth of 3 feet: Sand❑ Silt[3 Clay ❑ Peat d Sandy Loam o day loam ❑ f Hardpan❑ Adobe Fill Material............if yes,type............... ............ F (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[ I Zelf7`l-4e. ......................................... Liquid Depth ..................... .. Capacity .................... Type .................... Material...................... No. Compartments .................... p Distance to nearest: Well. ....................................Fours tion ...................... Prop. Line ......................Z 'f LEACHING LINE ' No. of ),Ines .--I_.-----•----..... length of each fine.... .............. Total Length ........ ........ ` D. Box .. ... Type Filter Material 4164ee.....Depth Filter Material . ...`...................r......� • , Distance to nearest, Well . Foundation ,1�./............... Property line .. ............ p` SEEPAGE PIT &' Depth p7�S'.`....... Dla eter J ......... Number ..... Rock Filled Yell,' No 4= Water Table Depth ... r................................Rack Size .fz ...... ... ............ 49 Distance to nearest: Wel! ......... ...........................Foundation ............ Prop. line ...................... REPAIR/ADDITION(Prov. Sanitation#Permit# ............................................ Date ............................... . .) i Septic Tank {Specify Requirements) ............... ... .. ............................... ... ------ ....... Disposal Fiala (Specify Re irements} ._ ... ... 4 ............... r .................._.......... ,e�C�- J �,.d.!e:- .. ...... < ._ .............. (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, grid 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'i Compensation laws of California." Signed .... . .............. .--•-... ....... . Owner ay ......... . . title ..... .r�:......................... Ili other than owner FOR DEPART ENT USI~ ONLY APPLICATION ACCEPTED BY ... DATE ... r.'. ...... BUILDING PERMIT ISSUED .......... �. DATE ..............•-.--------------...-----.... ADDITIONAL COMMENTS .././.. ..�Q..7.d..... . ....�........ £�----.... ............................................ ............ =------ .................................... ..... --- ... ...........................................,...:........................ .............. FinalInspection by: . ..... . ��.._,................................. .........................................Date EH 13 24 1-60 � SA JOAQUIN LOCAL HEALTH DISTRICT lI/? 3M