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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- Permit No. 6 ------------- (Complete - 94 (Complete in Triplicate) --------------------- ----------------------------------- 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 Cr31^+ ^- " nce No. 5A9 and existing Rules and Regulations. JOBADDRESS/LOCATIONa2.m�� ----- _ ,__:_fit llL + CENSUS TRACT ___-------_____----------- Owner's Name ----/D /rl�cr(sT__--� iP ✓__ _._ r_ -----------------------Phone _n Address ------- ----------------------------------------------------- City'ey jCt.A✓------------------------------------------------------- Contractor's Name ___ __. 40TG'---- ----------------License # Phone��?'Ya�, 57 Installation will serve: Residence ['Apartment House E] Commercial ❑Trailer Court ',❑ l Motel ❑Other --- --------------------------------------- J` Number of living units:_._i_-____- Number of bedroomsa2--------Garbage Grinder A140 Lot Size C FS Water Supply: Public System and name ..----------------------------------------------------------------------------------------------------------Private p , Character of soil to a depth of 3 feet: Sand'[lq0"'Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material ?QQ__-_. 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 tark or seepage pit permitted if public sewer is available within 200 fee PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size_!-_x`3X -� q p ��y!� Capacity�OW - Type � Material______________________ Compartments c2................. Distance to nearest: Well ----/�__--________________ ____Found ' n ---------------- Prop. Line�4P_�_________ LEACHING LINE [L]/ No. of Lines ____�_______________ Length hof each lin __ _ ------ ------ Total Length 1d�_'______________ 'D' Box -____-_____ Type Filter Material5J _ ______Depth Filter I _��_��-------------------____________ Distance to nearest: Well -.7Q__ ____________ Foundation _3Q--..--._--__---_ Prop ine. _�La______._-_-___ SEEPAGE PIT [ ] Depth __------ Qi ter ________________ Number --- - Rock Filled Ye No Water Table De ----------------------f-------------------------Rock Size ------------------ Distance to earest: Well ----------------------------------------Foundation -------------------- Prop. Line -----------------.---. REPAIR./ADDITION(Prev. Sanitation Permit r# -------- ----------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) ----------A1_.� _-._,(�7. /'-_--V- 5 .._ / ----.-7�;------------�-------- f Disposal Field {Specify Requirements) ___- --__ . ,Z�____ __ -------------------------------------------------------------- -------- E FI----------.v_--------------------------------------- f 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 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 gY + ------ ----- -Title I ------i X-1914_ (If other than own FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ !R-1.- DATE "' BUILDING PERMIT ISSUED --------- - -- ---- ----- - ----- -----DATE - -- ------- ----------------------------- ADDITIONAL COMMENTS -- --------------------------------------------------------------------------------------- ----- --- k ------------ -------- ---- ----- -----------------------------------�------ - ------ -------------- ---------- -- ------ ----- - -- --- -- ------------------------------------------- ---- -- - - -- -- ------------ Final Inspec ' -----Date ----- -----�--- `" SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M