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WCFOR OFFICE USE: 'APPLICATION FOR SANITATION PEP-11T _.... . ..-- Permit o. .... _ (Complete m Triplicate) ........3 --- ---------------- --- ------- I- .... This Permit Expires I Year From Date Issued Date Issued J-�___y�---- 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/L A N 4oZAf -------V.--.--------- ...`...r"... ...... �. a,. -_ /, F.. CENSUS TRACT ------------------------. Owner's Name �-2;_ -�Cy' .----- -----a- ---- ... Phone - Address -- -... ...-. V`L t City Contractor's Name / °. x- '- --- - - --------License # --.�4V.?,iP.yPhone ._.-----..------------------- Installation will serve: Residence ❑ Apartment House C] Commercial Trailer Court ;❑ Motel ❑ Other ----------- Number of living units: ..... Number of bedrooms - Y--Garbage Grinder --_ ----- Lot Size ______ 4..�-rt--.yam.--.. Water Supply: Public System and name ----- -- -- -- -------- ..................------------------------ ---------- -------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom C* Clay Loam ❑ Hardpan ❑ 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.) NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) , [ I � 'i �/` �_.... .. Liquid Depth ...fZ.-- - PACKAGE TREATMENT SEPTIC TANK S ------------- Capacity� D13� Type _ _ ,___.- - __ - Material-��Yt,- '�..- No. Compartments r.---------------- Distance to neafest: Well 5� _------Foundation ------1.__. . Prop. Line -_--.- ------..--. LEACHING LINE [ ] No. of Lines _ Length o each line __ A_CJ_/..(_ _ . otal Length .../.d4- 'D' Box . ...- Type Filter Material —Depth Filter Material ----41% _.-- __._ ..__..- -----`' Distance to nearest: Well .___- d_ Foundation --- Z� Property Line ._..-._ _-.. '_ / 11 I Depth ._ ...`�!tepth .�.- � Number ________�_____ ____/______ Rock Filled Yes� No >❑ Water Table �-- ------- - --------Rock Size Di j stance to nearest: Well ____.__._....-___!1�'._-_.-._.-Foundation -___.__,l��rop. Line ---- -------- REPAIR/ADDITION(Prev. Sanitation Permit=# ------------------------------------------.. Date --------.-------------------------) SepticTank (Specify Requirements) -------------------------------------- ------------------------------------------ ---------- ------------------------- ------------ -------- 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 Wo an'3 Compensation laws o California." Signed ,�- y - ------ Owner fa BY - J Title -'---�'- --- ---- - _ (If othe 'dn owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ !_`:�'..... ..._----- -- ------- ........... .... .....-........ ..._ DATE __..._t771! -,c.' - 1 �--...-- BUILDING PERMIT ISSUED --- --- -- -- ------- -----DATE - . ......---- ---------_- -- ADDITIONALCOMMENTS ......... . .. ... . -----------------------------.._..--------- ----------------------- ---- ----- ---- _..._.... .... ............. . ................................... F'_ ..- -.r. ---------- -------- ------- 1 s .... - _�, - ........ .____. __.. ._... ..... ... .. Final Inspection by: - :: 11�p - Date - - ---. .. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M