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c -+ A. -FOR OFFICE USE: ell APPLICATION FOR SANITATION PERMIT .......... •---••......--•-••--• ... Permit No. -_�� a1.-. (Complete in Triplicatel . This Permit Expires 1 Year From bats Issued Date Issued ly171--- 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. 949 and existing Rules and Regulations: JOB ADDRESS/LOCATION-_�.- '�}`!7 L ` -------VI' --------- — ------)...................CENSUS TRACT . ........ Owner's Name ... 1 :_teprr{ . .. f9. �.f� --��..,. .........,_...-•-•-----•••--•:-----------1------------------ ---Phone .................................... -SJ�}. rr-4 '�-- ------------ City l� C— Contractor's Name _ _W�n t�,>iz�-•-----•...... ............................. =--:._..License# . ----: Phone ... Installation will serve: Residence Apar-tr'ent-Housed Commercial 07railer Court '❑ Motel OIC r-------_--------.--- ,'-•-•----------- Number of living units:- �.._._ Number of bedroom ._�. -. Lrbc! cinder ../Ud... Lot Size _/ R ?q -------••----- I - ^ ' Water Supply: Public System and name ..........l-_.-. -� --.---- Private L� Character of soil to a depth of 3 feet: Sand VSilt Clay.❑ Peat❑ Sandy Loam Clay Loam '[- Hardpan 0 'OASobe [:J,4111 Material—No--- If yes,type ............................ (Plot plan, showing size of lot; location' f'syst€m 'in relation to wells, buildings, tc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or eepage pit permitted if public sewer is a ailable within 200 feet,) V i - PACKAGE TREATMENT [ ] SEPTIC TANK' }`-- Size: ............... -----• -_--- --- Liquid Depth ..._.----------- Capacity ................ Type ...... Material ` No. Compartments ........... .......... Distance to neares Well .___-_.::-_-.__:__..--:•.:.:__....Foundation _. ................... Prop. Line ...................... LEACHING LINE ( J No. of Lines ---------- _ __ Length-of`4&h ...........:...... ... ..... Total Length ............................ 'D' Box ............ Typ Filter Material ...................Depth,Filte Material -------._-..----.-.-.--.-..-..-----••-.---.- C Distance to nearest: ell ________________ __�;;_ Foundation . _F..- ... _ -------.- Property Line ...__........_....._.__. SEEPAGE PIT [ ] Depth .................... Diameter _-___---.__.,A_ Number .___�_ .� ----------- Rock`pilled Yes C] No C3 Wafer Table Depth ------_-- -_--------_------_------- - Rock S ze .... - u) ._Distance tofearest: ell ...._...•...........................•--Found C do - --------_-- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# - -----•-.�---•---=--_--,--. - 'Date .`_ ...�. .- _z------ ---------- } Septic Tank (Specify Requirements) ..... -.... .••--- .--••--•................. .. ..:{•,-;.._............. -----------•.--•-_: :-••-------------------- gr Disposal Field (Specify Requirements) -----a �J _._.�4�C... ��:...}}' ..-- ...irt �. =.- ............ . .......494tH... . - -11 :-----•-•- ..........................................-•---• •_-,t�-:.--------:A_............................ .................... • I I�-� ------------- •-----•---•------•....................••-•------•......• --------== - �f, - (Draw existing and required-addition on revs se side) 1.I hereby certify that 1 have prepared this application and-th'a't the work' willF be donor 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: a C 1.1 "I certify that in the performance of the work for hich this permit is issued, Ishall not employ any person In such manner as to,bec e• ub a an's Co ani* laws of California.' 1 f . 1 .' Signed f_. ---- --------------- -------- Owner' By ------------------ • -.. -------------- ..............-------- ------ Title ( ..__._...{..... ' !... ... - If other than owner) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY __`77R_'V------•--------------------- . --------------•----_---.-----........... DATE ....�---^•7-/7-V"....•.. -.... BUILDING-PERMIT- ISSUED-- "". .-=. " =:_. ".. ::.:_ .._____.::..., _- .::- :::-:.4.--...DATIi :�:— _ ._•:,-..�r----•-----•--- ADDITIONAL COMMENTS --------- `-/��. _ .. .__ a.`ts_'.^_. r............--•--•-•--...--••-- ---------------•. ...... .............. ...... -..............................'---- - - `--- �7+�-w---"•••_� ..' ____.. '...._._.... - .._........ .......- . •. .................. ... ... ......Final Inspectio�rby l .�... ••••• ...... ... . !/ -._..__... Date .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M RC