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_FOR oF'ICE USE: APPLICATION FOR SANITATION P rIT 7 I '• -=--------------- --------=------------------------------ Permit No.. ?--/ (Complete in Triplicate) ----------------------------------------------- ----- Date issued Z_-_Z�.=J This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: `I JOB ADDRESS/LOCATION .-------- -------- -----------9\,LVJarV-------------------------CENSUS TRACT Owner's Name ------------- 1 u. `r 1 h------------.Q).P_v..-- j-' ..--------.. --------- -------------------Phone ------------------------------------ Address ------------ ------.-as---•----------------_---------------------• ....... City <------ - ��Qh----------•------------------------• ----------_---- Contractor's Name 69 ;a a ----0�- +----------------------License # .G��I_ __ Phone -- Installation will serve. Residence[Apartment House-F] Commercial ❑Trailer Court C] Motel ❑Other ------------------ ----------- ----•-------- Number of living units:-----i#------ Number of bedrooms ---. _.___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 Hardpan ❑ Adobe ❑ Fill Material ---C_l-1_a_ 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 p seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE TREATMENT { ] SEPTIC TANK Size-------1__13.4.0____C-4_--.----- --- Liquid .Depth ___ _._ _...._____. Capacity ---)-aWt Type No. Compartments ._:-. .-------_--- Distance to nearest: Well -----_1. 0 ............---------Foundation -----W- ----._ Prop. Line ...--l --- ...... LEACHING LINE No. of Lines --------�2------------- Length of each line-------7, - -----, Total Length :-__--� v_-__--------- D' Box ----1------ Type Filter Material -__1-114 ock—Depth Filter Material ----- ----•----•---•----- •---------- Distance to nearest: Well ----1-410----------. Foundation ----- 0`----------- Property Line ----gip•.............. SEEPAGE PIT Depthk-!f _k_I Diameter ________________ Number ________-_A-_____- -____ Rock Filled Yes Na i0 Water Table Depth ------- ------------------- ....... Rock Size ------- I�-- ------------ •-- Distance to nearest: Well --------1_3Q--------------------- -Foundation ---2Q---------- Prop. Line ---•--�?-------•_-_-- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---_---------.--------------------) Septic Tank (Specify Requirements) ---------------- ------------------------------------------------------------------- i 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- "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 G ----------------- ------------------------ Owner ------------ By ------�,4,r '�-------- -- --------------------------- Title ----- ------------- (lf other than o ne FOR .DXPAATMENT USE ONLY APPLICATION ACCEPTED BY ------ ----'-AX----------------------------------------------------------------------------- DATE ----9.Za--. ,�------------ BUILDING PERMIT ISSUED -------------------------------------------- ---------------------------------------------- -------DATE ---------------------------------•---- ADDITIONAL COMMENTS ------------- - ------------------------ - -------------- ----- ---------------------- ---------------- --- -- -----------------ZS ------ ----�--- -- --- ----- = •---------------- ----� -- Final Inspection y: -------- - Date -------------- ---------- ----- - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M