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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT 71-973 - ------ -- - Permit No. (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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 9L�a- _�_/r[Q! og -.----.-CENSUS TRACT -------------------------- Owner's _ ----- Owner's Name F1O-fie-W-----w�..-----66 4--h-e y---------------------------------------I-------_---------Phone - Address . �6- gZ_POS 4- /u�.- -------------------- ---- city rP f P�----- _--------- -- -------------------------- Contractor's Name --O-W/7-t r--------------------------------------------------------------License # --------------------- Phone ----------------------------- Installation will serve: Residence PQ Apartment House❑ Commercial ❑Trailer Court C) Motel ❑Other -------------------- -................ ,�/ v Number of living units;.._'-----_ Number of bedrooms _.___.Garbage Grinder 11/0---- Lot Size -_ _.___..._.____-.-. Water Supply: Public System and name ----------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe nl 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.) V NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size y' Liquid Depth ________._-._.,_._.- `, �� Capacity .4bp___-. Type ./�a&M04Aaterial------- No. Compartments __A----___.---- jy}rvi[ N V629 6"pew VTA' Distance to nearest: Wel[ _.7J�___________________..__Foundati n 5 ___ _ _ ___ Prop. Line ___� ___..._-- - LEACHING LINE No. of Lines _--. .(�_ �sTL�ngth of each Lline_.�'Q_ -_._.__._ .. Tot Length __, Q--------____...... 'D' Box _ Type Filter Material _._.^-----Depth Filter Material Distance To nearest: Well ��____.___.... Foundation - --------- Property Line ............... _ SEEPAGE PIT [ ] Depth -----------------. Diameter ..- ....... Number ----------------- ---------- Rock Filled Yes ❑ No Q Water Table Depth ---.------------------------------------------RockSize ---- Distance to nearest: Wel[ -------------.-------_.................Foundation / Prop. Line .................. - REPAIR/ADDITION(Prev. Sanitation Permit# -_/7Z? ._-------- -_____ Date 13lL6.f'------.-----I Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ----------------- ------ L --- -------------------------- --- -- ---------- ---- --- ------------------------------------------------------------ ----------- -------------- -- ------------------- (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 subie to Workm 's Compensation laws of California." is Signed -_!�L-°- - �-�- -- - -- ---------------------------------- Owner By --- ----------------- ------------------ Title ------- - - (if other than owner) FOR DEP TMENT USE ONLY ~ APPLICATION ACCEPTED BY - -- ------ DATE -`- --- ----- ------------- ------- BUILDING PERMIT ISSUED ------ - ------ ---------------------------------------------------- - --- - --- - - ----------DATE ----------------------------- ---------- ADDITIONAL COMMENTS -------------------------- ----------------------------------------------- - ------------------------------------------------------------ --------- ... ---- --- -- ------- ------ --- ----- - - -` - - - - Final Inspection by: --- -------------- --- -- ----- - -- - -----------------------------------Date ------- -�-W--- - -------- 40 ,z le. �st /VV SAN JOAQU N LO AL.HEALTH DISTRICT (! ��1..�4,.Qw„ CTS I o-z 'f--7 z D./L. ']-,.��n....9