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FOR OFFICE USS: APPLICATION FOR SANITATION PERMIT I� 7-3 -77,--- Permit N . -. No (Complete in Triplicate) ; ---------------------------------------- 3 1 - 73 ' Date Issued This Permit Expires 1 Year From 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 County Ordinance No. 5499 and existing Rules and Regulations: JOB ADDRESS/LOCATIONTWO------- --------RD-` ------- ------- � q ` J'`� _CENSUS TRACT _________'-�- Owner's Name ----�-------- - _k__ /�-- ..�- Phone ; �y �y ��f2" ---------------------------------------- Address b_._�a'- City Contractor's Name ... -----------------------License # AY?Y!Y,f--- Phone ` --------------- Installation --7 TInstallation will serve: -Residence ❑Apartment H65-se❑'Commercial ❑Trailer Court ',❑ Motel ❑Other «1�i_-/�QUS __- Tf�00M Number of living units:---—----- Number of bedrooms -- ___Garbage.Grinder--------- Lot Size 451-W-19? ------------•---- Water Supply: Public System and name - ------------------- ----------•-----------------------------------------------------------------------------Private,] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,e Clay Loam Hardpan ❑ Adobe.l] Fill Material _!!7�___ If yes, type ----"---------------------- (PI'ot 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 orseeps pit permitted if public sewer is available within 200 feet,} J PACKAGE TREATMENT I ] SEPTIC TANK Size------- -------------- Liquid Depth _4/ ---------- Oq 2�__••._.- r Capacity �40 - _"T __________ ____ __ Material�rz�� No. Compartments .-..__,___ .-_- P tY ---- - -- Type Distance to` nearest: Well _-----__00__j_______________Foundation ------- Prop. Line --- -------- J LEACHING LINE ?1""�No. of Lines ------- --------------- Length o ne---r -_ Total Length ------------ .7 " 'D' Box '-"'----- Type Filter Material ____________________Depth Filter Material _)_ '------------------------------ V) Distance to nevrest: Well ------ ..._.tr Foundation ------------------------ Property Line ___________ JJ SEEPAGE PIT Depth _-_.______ Diameter _ U_____ Number .__--�--.-_-_.--_�_ _�_r Rock Z2.1111d YesNoi0Water Table Depth ----f�,,-�-------- Rock Size �- =� Gp Distance to nearest: Well __-_ffl9--------------'.--------Foundation ----.-�-------- Prop. Line _._--------....-___-_. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------.) Septic Tank (Specify Requirements) ------------------------------------------------e-------------------------------------------------------------------------------------- 4 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 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 Wo kman`s Compensation laws of California." Signed _. ; -- ---- Owner ------------------------- IBY -=---- -------I---- - ----. ---- - - --- ----- - ---------------------Title -------------------------------- - ------------------------------------ (If other than owner) FOR DEVRTMENT USE ONLY' / -� APPLICATION ACCEPTED BY - ` DATE Z ------- BUILD.ING PERMIT..ISSUED ---------- D ADDITIONAL COMMENTS ---------- " .:, L -1/Y1'_�_ 'Ti----- - -- - ------- --1�--------------- ------------ ---- - ------------------- ' '-------- --- ------------------------------------------------- --------------- .•:. , --------------------------------- _, d +c ----------------------- ----------------------- --------------- ------ -------------- --`r`------�- -----' ----------------- ------ ` Final Inspection `` -------,- = ------------Date --- -- - -------- ---- --•- ----- F SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'68 Rev. 5M