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12 FOR OFFICE USE: �' .. PLICATION FOR SANITATION PERI' � - . - _.. _ __- -------- � 11� (Complete in Triplicate) Permit No. --9Ap --------------------------- This Permit Expires 1 Year From Date Issued Date Issued ---- Application plication 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/LOCAT/^IION ..620_0_._?_.Q_____-4c_,----- I /Y. 4AI--_-----CENSUS TRACT _ `�.............. Owner's Name / 1U - N-A _ -N - --------------- - Phone . �fg - ,2. Address ---------7_;7/1---------cf 0-R4_4-------/N__-------- -- --------------. city %GL''lC7?11/ --- -- /` Contractor's Name -.��( f -----�1 / --------s5'[,i'•--------------- -------License # /-2.2-$g3--- Phone 10&_S22461�-- Installation will serve: Residence Apartment House Commercial ❑Trailer Court i❑ Motel ❑Other ---------------- ------------------------- Number of living units:---k1. Number of bedrooms __A____,Garbage Grinder A/D-_. Lot Size --a-0...... `-..__..._.._ Water Supply: Public System and name ----------------- .------------------------------------------------ -------------------------------Private„ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam..0 Hardpan IW Adobe ❑ Fill Material -_- ---- If yes, type _____-.___._-__-_--:-_-_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) e NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) XJ PACKAGE TREATMENT [ ] SEPTIC TANK$Q Size--- ,{ �_.._-.___-- - Liquid Depth -- -----I---------------- 0 Capacity 10?9Va __ Type)12:J!9__Material_42W110,0�?7--No. Compartments ,.�. ---_--_---:-_-- %q i _ Distance to nearest: Well _.,Sj,�_------------- -----_.Foundation __l0............. Prop. Line _---__-_.___. � LEACHING LINE No. of Lines Len r fC] 2 -- -. Length of each line- �'� ---- — Total //Lepngth - �w---------- 'D' Boxy. __. Type Filter Material k4�k...-Depth Filter Material -.6-1--��....___.----------___.__-- Distance to nearest: Well ---S-1v -------- Foundation ---/O`--____. ---- Property Line ........ SEEPAGE Pit ] Depth ._IS----- ---_ Diameter ,3,7"_____ Number -----�__-_..----------- Rock Filled Yes No ❑ ` Water Table Depth .. . ..----._.-----------_--.........Rock Size Distance to nearest: Well ...1042_---_-----------_---_--_Foundation _.l Q.......... Prop. Line ._ ir..._..__... REPAIR/ADDITION(Prev. Sanitation Permit# ........---------------------,------------- Date --------------------- ------------) Septic Tank (Specify Requirements) - Disposal Field (Specify Requirements) ------------------------------------------------------------ r --------`------------------------------------------------------------------------------------------`--------- ------------------------------------------------------------------------ (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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's CompensatioR�laws of California." Signed ___ ___________ Owner 8y - - + - - -- ,£.: Title .__ -- -- ----------- - -- (Ifo r than er) -------- ------ FOR DEPARTMENT USE ONLIt APPLICATION ACCEPTED BY ` -7-"c1 Gy------------ ---- -- ------------------ - --------- DATE f - ------ BUILDING PERMIT ISSUED ---- -------------- ------- ----------------------------------------- - - - -------------- -----------DATE ------------ ---------------- ----------- ADDITIONAL COMMENTS ------------------------ - -- - - - - --- - - -- -- ` ----------------------- - _-------- ; - .- ---------------------------------- --- - --- - ----------------p-- -_-_ -__ - - ------- Final Inspection by: �-?.2,<,i ------------------Date _{.-`I-��----'_��/' -------------------------------------------------------- '-- --------•-'------ SAN JOAQUIN LOCAL HEALTH DISTRICT MJ 1'4 E. H. 9 1-'68 Rev. 5M