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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT i. 3 ........ ......................I.......... .._.......... Permit No. _.7kA.---.. (Complete in Triplicate) ' ...................................................... Date issued ............. This Permit Expires ] Year From Delle Issued .. Application is hereby made to the Son 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 aeexisti�n i R s a d ijegulationY: �4 .O..CENSU(SL TRACT ................ ...... JOB ADDRESS/LOCA tb'/ �. ............. w " ." f' /7;`�C��. .................... ........Phone .................................... , owner's Name Address ...._._.. f... , ...... City ... ...................................................... l ! ..� . ...... Phone Contractor's Name -_--.'- •--- .c9-d.-- -w�••••• - license 1 Installation will;serve; Residence �tment House C] Commercial ❑Troller Court 0 ' Motel ❑Other t ? . . Number of living units:.__(........Number_of bedrooms .......Garbage Grind Lot Size . -• Water Supply: Public System and name :............•-• ..._ -- ---....._..------.......... Private i Characfer of soil to a depth of 3 feet. Sand n Sils❑ -Clay �.t p Sandy loam ❑ Clay loam 0 { Hardpan ❑ Adobe iMaterial -,k10. If yes,type ............................ {Plot plan, showing size of lot, location of. system in relation-to wells, buildings, etc. must be placed on. reverse side.)..N NEW INSTALLATION: (No septic.tank.or'seepage pit permitted If public sewer is available within 204 feet,) / , � A PACKAGE TREATMENT [ ] SEPTIC TANK Sia � Liquid Depth . X12. . ..., . ... .......... . Capacity ..�- Type ateriali'.�1�. - ' Compartments ...................... . f Distance to nearest Well ---'..-----•`•T�••...Fooindotion . .�------- Prop. Line .� i LEACHING LINE No. of Lines ---- ---------- length...oU"eacAli.�e. C�-�.��-- Tot I Length . -- a Le }�7 Box .:. ` Type FiIter.FMateriol ..... .. ••Depth Filter Materia! - .......---••-........... . /. ............. PropertyLlne `S , •. ;stance nearest: 1Nell,;.._.::r.. _ ._.-�.. Found atinn /.0-Z ,� �-- '� _ ..... Number ..:._t .�......----- Rock Filled Yes. L 'No p meter .. .... SEEPAGE PIT Depth�_.... p Daa � j e Water Table De th - Rock Size :----....---•- 4 } r Line .. ......... ... f --...Founds#ion Pop. Distance to near�tc`Well .........,�_�_�..�..---•--• ----�•---•----- -- - on Permit# ...... ........•"___---. Date --------....------•------... • REPAIR/ADDITION-(Prev. Sanitati ) t J.r. _..--••---•-••-_.. Septic Tank (Specify Re uirements) - 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 lieen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued,'l shall not employ any person in such manner I as to become subject to Workman's Compensation laws of California." Signed -------- ------- ----------- ------------- -- i ......... Owner B �_... .... . Title :tel��1.1��• ------ i {If other than oner) FOR DEPARTMENT USE ONLY DATE _ ..i9/�. ..._.. APPLICATION ACCEPTED BY ...� : . ---. -. -- -- ,;.; BUILDING PERMIT ISSUED '' DATE ---------------•-••-••---••----•-- .._.... ---•--. ••• •••-- ---•-- -••••••...••---• = ADDITIONAL COMMENTS . ....._ ......_...............i••-.........•-••-••.........._..-••---••---•---=---•--•-- = '....:..:` . S .....................................................I........... ..._. ..__•__• .....................................................:..:,............................................ .......................................................:............ .. ._ __.._ .... __ . .....................__.._ ......._-._ __ ............ Final Inspection by: Date .S"a3•-••- 4 - _ .. - .. .................... . ....................... ..... --SAN.,J AQUIN LOCAL HEALTH D15TR(CT ,,.._. _ 7/72 3-M- I a r i i 5 SLA o.... CAA - ._