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FOR OFFiC;E USE: r '1PPLICA7ION FOIA SANITATION PlEe' --------- ---•- ----- -------_- - -" (Complete in Triplicate) Permit No. -.--------------------- ' I - This Permit Expires 1 Year Fro rn=DWeIssued Application is hereby made to the Son Joaquin Local Health District,,fora permit to co struct and install the work herein described. This application is made in compliance with County 0`rdnance No. 549 and existing Rules and Regulations: r f JOB ADDRESS/LOCAT ON /.-- � ; ,. r-- CENSUS TRACT -------�.".--••""-"-- Owner's Name ►-1 �, ,L, L, ---e_4 _✓Yi �11/_ ' AddressL2/�j C ------ ------------ -- -- - -----------. 4 n Contractor's Name . X , " �, Ola75 � --___.License � � 3'— p_ • � -- �---- Phone ------'-- ------ - Installation will serve: Residence [Apartment House,(] Commercial E]Trailer Court !�] Motel [7j Other --------------------------------------------- Number ----------------- -=---------- -- ----Number of living units:__,---- Num ber_'of .bedrooms -------Garbage Grinders°+' _--_ -- --- "�.�--�-�� Water Supply: Public System and name -!"""- _ ,:I: Lot Size .r------ "" -----.•--- � -------------------------------------------------- --- - -------Private - Character of sail to a depth of 3 feet: Sand.E] Silt❑ Clay E] Peat❑ Sandy Loam [ Clay Loam Hardpah,❑ Adobe.I] FiII Material ------------ If yes, type ---------------------- - --- ) (Plot plan, showing size of lot, location, of%;$ I m .in relation-..to"wells, buildings, etc. must be placed on reverse side.) ' NEW INSTALLATION: (No septic tank o,r seepage pit permitted if public sewer is available within 200 feet,} i i r PACKAGE TREATMENT [ SEPTIC TANK'[ Size-- - ". '- ------------- Liquid Depth'r .______-•--""---- �j Capacityll C?a '- '-_. Typ�1,t, . , �� Material---------------- -"--- No. Compartments •---"""-- Distance' to nearest: Well _/--Q� ----------------Foundation /..C1_"-_------ Prop. LineC�_____-••- \n LEACHING LINE1. ---- ----- Length of each tine [ ] No. of Lines �_-._ - ------------ -- Total Length AP9 ----- ----------- 'D' Box T e Filter Materi Yp. a� _: __-- """Depth Filter Material -- --------------------------- Distance -----_ _ _---- Distance to nearest: Well _-.-_•.. Property Line ----------SEEPAGE PIT3-4-.X-4?----` Number __.._--__ Rock Filled Yes [.� Depth �,�..��._----_---- Diameter .... .. ... ,.._ Water Table Depth ...... ------------±`_-__>_•__+-----_.:Rock Size to nearest: Well ��---------- ------------ - Distance �...,_. .5 : ; / Q'G_. - -Foundation lfQ / 4 REPAIR ADDITION Sanitation Prop. Line -.""."--___""-..." f / (Prev.( on Permit# ------------------------• Date 1 Septic Tank (Specify Requirements) .__--- --------- ----------- -----------------------------------I------------------------------------------------------------------------ Disposal _-_ - ---------------------------------------- Disposal Field (Specify Requirements) - ---------------------- ----------------- ""_.."--___."___-" .____.-- """.__""""-_.""- - -----------k_.----_-----__--.--.------_.----------------i----._-_-- -- (Drawexisting an _. qe -aon,on.rle�erse side) ------- I hereby certify that I have prepared this 1ppplication and that the work will be done in actordiince with San Joaquin County Ordinances, State Laws, and Rule.,,', Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: i t "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 bT blect to Workman's Compensation laws of California." Signed ±By -------. - (If other than owner) ----------------- Title --• . ....... -...z_°�c�.. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY BUILDING -PERMIT ISSUED _"""--_ --. DATE 1 _ ._ --- -... - --- a ATE ENTS ""..ADDITIONAL COMM .. f�. ----- . ------- - _ r -- ------- ' -� '---- --------- ---------- -------- ----------------------------------------------- ----------- .Finalln j ---------------------------------------------- ----- ----- .- -�''----- ..r:�.--- ---- � ----- ----------------------- ------- ---- ate --- SA N --SAiN JOAQUIN LOCAL HEALTH DISTRICT j E. H. 9 7-'68 Rev. 5M