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FOR OFFICE USE: - IE APPLICATION FOR SANITATION PERMIT 11 w {Complete in Triplicate} Permit No: ------ --------------------- ---------- - ---------- ------------------------------,'.____ This Permit Expires 1 Year From Date Issued Date Issued _P2-k_-_70 Application is hereby made tc the'San.Joaquin Local Health District for a perrulif"to construct;andinstall--the-work herein described. This applicatio6lis made !A'compliance with County Ordinance No.1549 an existing Rules and Regulations: c ^ > JOB ADDRESS/LOCATION.I __ �CIy___ _ c�f t i "^- y� - -- .- --- -----------------CENSUS TRACT ----------- -- Owner's Name d ) - - -- Address f Phone _ _ - - ---- -- �------ Contractor's Name _ $ `� .License # -;25.71._7j_ Phone A/44 - - --- ---- - Installation will serve: I -. f ,`�Residence Apartment House-❑ Commercial:❑Trailer Court ;❑ Number of living units: �I ❑Other _______ __- -------------- --------------- g ------- um Number fof,ybedrooms __O/--____Garba_ge Grinder _.__________ Lot Size _� 44 Water Supply. Public System and name'.`;.+------------ ---------------------------------------t . .._ ..:.* - -------------•---------------------------------------Private Character of soil to q depth of 3 feet: Sa nd❑ Silt❑ Clay ❑ Weat[:1 Son Loam Clay Loam.0 Hardpan ❑ AdobesFill 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 se tit tank or see I 3 p a e it emitted P g P R if yublic sewer is available within 200 feet,} � PACKAGE TREATMENT [ ] SEPTIC TANK .--- -- Liquid Depth --- __________________ �� .. TYpe /[ sMaterial No`s Compartments C pacity¢` . i Distance to near t: Well ___ # s Foundation --- Q---------- Prop. Line .?--- - D l R � t r LEACHING LINE 'b Noy of Lines __: Length of each li e__ --_-----___-- Total Length Box � Y Type Filter Material 1l , Yp _ Depth Filter Material Distance to nearest. Well ___ 7 ___-_------ ' Foundation— 0 Property Line------------ SEEPAGE PIT ______ Diameter [ 1 Depth ------------- Number --------------------- Rock Filled Yes 0 No .❑ Water Table Depth -----------Rock Size Distance to nearest: Well ----------------------------------------Foundation --------------------- Prop. Line ------------- 9 t REPAIR/ADDITION(Prev. Sanitation Perm, it# -------------------------------------------- Date --------------•---------------___-) Septic Tank (Specify Requirements) --F______________________ Disposal Field (Specify Requirements) ------------------------------------------------- il t --- ----------------------------------------------------- ----------------------------------------------- -- ------------------------------ I �� (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 be ubject At ' m orkn"s Coion laws of California." Signed -------- - -- -- --------- -------- Owner n (If other than o By ------------------------------------------!I Title ------------------------------ weer} , OR DEPA-RTMENT USE ONLY APPLICATION ACCEPTED BY-.-,- �------ --- --------- ----------------------------------------. DATE -_&--7C ----- BUILDING PERMIT ISSUED ---p__�"_-----__ -------------------DATE ---------------------_- ----------------------------- ------------------------------------ ADDITIONAL COMMENTS ___1i__ _ ___------------------ ----------- ---------------------_-----------_------------- _ __--______________ -_ _____________________________________ Il _______ --_.________________-_________________________-__._______________________ y ______________________ ----------------------------------------------_--------------------------------------------------------------------- ------------------------- -----____________________________._._.__________.____.____________.__________ ___________ _ Final Inspection--b y: ,. ------------ ---------------------------------------------- -------- Date __�26-70 ----------------- I° u SAN-JOAQUIN .LOCAL HEALTH DISTRICT E. H. 9 ] '68''Rev. 5M. t ;