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FOR OFFICE USE: APPLICATION FOR SANITATION PER,. . . ....... - - ---- 7.3—X63... (Complete in Triplicate) Permit No. .. ............ - -------- ------------ -- 97 This Permit Expires 1 Year From Date Issued Date Issued --9'3y 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ............. __pS�<__rjl'f///UTEnNSUS TRACT .. Owner's Name - _r� -`�Z'--.....k`'--�--------1�/�.�?C.!'f"------ ----------- --__..........Phone --------------...._..........-- Address _-----/�-SG-/ ...__-5i ;V-A -A� ) City ..._.._... - -- ----- ---- ----------------------------------------- Contractor's - - - Contractor's Name _- _1�� FU Flt,-_----------------__- -------------..._..License # _07 5 ko -. Phone _9 �.:IV_ Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court Motel ❑ Other Number of living units:.__.... Number of bedrooms ..e�-----Garbage Grinder ______ Lot Size -----.---------------_-----..._.__------ Water Supply: Public System and name --- -------------------------- -------------------------- Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay ❑ Peat❑ Sandy Loam _N 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 avail ble within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] p Size...S�st- .. Liquid Depth . .............. Capacity IQ"...-..-- Type / MCA�Material--..--------....---- No. Compartments ------a.........-. �[ Distance to nearest: Well -------------.----------------------F ndation .� _�_./. Prop. Line ....... LEACHING LINENo. of Lines [ 7 C2_ _. ..._.. Length of each line..- 07otal Length ... .-.. .. -_. .2-Lp0 An 'D' Box ..../...... Type Filter Material //j6.YjAaDepth Filter Material ...../51....._--------------------------- yA Distance to nearest: Well .___._..-____.- Foundation ...... Property Line --- --__-----_------- �} SEEPAGE PIT [ ) Depth ............._.._ Diameter .._ ----------- Number ____.................... Rock Filled Yes ❑ No ❑ eS Water Table Depth ......_.--------------------------------------Rock Size ------------- ------------.- 9 Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------_----.------..- REPAIR/ADDITION(Prey. Sanitation Permit# -------- ____. ---_--------___----_-.. Date ----------------------------------I Septic Tank (Specify Requirements) - --------__.---------------------._--.---------------------------- ---------------- ---------- ----------------------------�1 Disposal Field (Specify Requirements) ---------------------------------- _ -.-----___--------------------------------------._----------------------------- ..---------------------- . ................... ._...........-......................----.. ------------------------------- (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, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 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 suble to orkm Compensation laws of California." Signed __4 ........ Owner By ........... -- ------- -- ------- ---- - ----- -....._..._..... ----------- - - - Title ........ - ........... (If other than owner) FOR DEPARTMEklT USE ONLY APPLICATION ACCEPTED BY .--- ---- _.._.---------... ----- ----------- DATE ----- .- - - ----7 --- - - BUILDING PERMIT ISSUED ... .. -- ---- 1 ---- D - - ADDITIONAL COMMENTS __�� - -y � � kO--- -------------------------- -- f� L - _. -/- __...... - -.._.. --------- - -,/� - - ...LJOAUIN ---------- -- - ----------- ------------------------- ------ Final Inspection by: --------- -- `..Date - .. -... SAN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M