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FOR OFFICE USE: --------- APPLICATION FOR SANITATION PERi,.4 (Complete in Triplicate) Permit No. ._._Z3_�_-7:... --------------------------- -- ----------- Date Issued __:q" ....-3 __. 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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIOV?� f� ---- =---- -- 74"o— TRACT ----- ------------------ Owner's Name - - ---- __ w -- -------- - -...... -c9� L---- - -------- ---------..-Phone N?7!__d T7------- r Address - - - -- - 4 (6/�Q - ._ .. - - -- - - City -�y� llzl 4l tit - - - - ---�-y---- Contractor's Name ----- --- _----------_-----------_.-----_.___.License # ------ Phone Installation will serve: Residence❑Apartment House-E] ❑Trailer Court C] .. Motel ❑Other Number of living units:-----I_._. Number of bedrooms _3�_Garbage Grinder -------- 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 0 Hardpan ❑ Adobe ❑ Fill Material ---------__ If yes, type ------------- _-----___._ eC (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 available within 200 feet,) _ .r V PACKAGE TREATMENT [ ] SEPTIC TANK �Q Siz __.._ ��.X__A--------------_------- Liquid Depth _S _...__._.-.--_ Capacity Cll _ �f _ Type __ Material.-CD Xa< No. Compartments .__ -c____._-.__ .. Distance to nearest: Well ------- r_......____----Foundation ------------ Prop. Line ___. ._:+.__._ LEACHING LINE No. of Lines -------- Length of each fine_.----Ar ]___._.-.._ Total Length .._h..�._.__..... 'D' Box ------- Type Filter Material -b@n_-:.....Depth Filter Material ----- Distance -_ ` r '� .. .Property ' Distance to nearest: Well ___....5�_"-- Foundation ----�0___..._..._.. Pro a Line 1`------------ SEEPAGE PIT j(� Depth -2S_ _-_-_ Diameter _ _ __ ..... Number ...___..1'_.___/___.__ RockLfilled Yes No ❑ Water Table Depth --------------------------------.._.___----Rock Size --IA"_6�........ ---- Distance to nearest: Well ....__,/*� -----_'f- .-..--------Foundation ---/A_t----- Prop. Line ___. ....... REPAIR/ADDITION(Prev. Sanitation Permit# ______--------------------------__------__ Date ------------------__.------------I .. Septic Tank (Specify Requirements) ---- ---- Disposal Field (Specify Requirements) ----------------- --------------------------------------------------- -- -------- -- -- ----- ----- ---- - - ------------------------- ------------- (Draw existing and required ------------------- -- uired addition on reverse side) ` 1 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: "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 Workman's Compensation laws of California." Signed ------ ----- --`-----�._ Owner r By --------- ------"----�.�'----- --�------''�--"- ------------------------------ Title - ------------------------ ----- (If other n owner) FOR DE N USE ONLY v APPLICATION ACCEPTED BY - - - - ---- - - --- -------- DATE Z Z-z.._7 ---------- BUILDING PERMIT ISSUED - ------ ----------------------------------------- ------------------------- ----- -- ---DATE -- - - - ADDITIONAL COMMENTS ___�_� 0_i ,.,,t[ f,J / - -- - --------- ----- ----- --------- ---------- - - ------------ - ------------------------------------- --------- --- ----- -------- ---- ----- ------ -- -- - - - - - - - -- - L Final Inspection by: -------- --- — - - - .Date - — SAN JOAQUIN LOCAL HEALTH DISTRICT 117 F H 9 1 2A Rvv SM