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FOR OFFICE USE: APPLICATION r:OR SANITATION PERMIT . - •� - ri Permit No. _•................... (Compvete in Triplicate) " -------------------------------------------- --------------------..................................... This Perimit Expires 1 Year From Date Issued Date Issued L cl3_a-7a-/3 Application is here15y.-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: t�o RD'D S'- et- _0V �2>fi-�J T JOB AQDRESS/LOCATION _ .__ ._____CUS TRACT ..___...-_..__-----..__. Owner's Name -... �/t.1 4�___-ad____. 1}_ __Phone; ��Z r� --•-- AddressQ - Y` Cit -•---------- Contractor's Name -------- ---- - -, _ _t--- ----�---- ------------------ ------.License`# __l6_4S'l J------ Phone -_-- Installation will serve: Residence ❑ Apartment House�❑ Commercial ❑Trailer Court El Motel ❑Other -______ Number of living units ------- Number of bedrooms ---------.__Garbage Grinder ---------- Lot Size ____________________________________________ Water Supply: Public System and name -----------------• .............................. ------------I---------------n----------------------_--....Private Character of soil to aIdepth of 3 feet: Sand n Silt❑ Clay ❑ Peat❑ Sandy Loam K Clay Loam fHardpan ❑ Adobe ❑ Fill Material ..--._._____ If yes,type ____________________________ (Plot plan,-�shbwing size of lot, ioccnC f5'6f system elation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j 10 PACKAGE TREATMENT `-- [ ] SEPTICTANK� ,gyp Size.��-�------------------------------- Liquid Depth ._..�.Y____________- �'` Ca Cit � � T efi��T_--___ Material No. Compartments ---. -_ __....__ p Y YP ; p C Distance Ito nearest: Well __I_ __ ___�"-_-__.__-__._-_.__Foundation 4W_� _ _- Prop.line ---.6o_f------- LEACHING LINE No. of Lines ._....--`�'...__.___ Le` tK of each line--------- ............ Total Length �64__.-----I...... DQa1v ,0612 'D' Box --1--------- Type Filter Material`�_��------Depth Filter Material ../- ------------------- •------- f -� f Distance to,nearest:_Well _-__ - --_- Foundation _/0_.f_________ Property Line . �^ 6EEPA [ ( Depth ___ a_� _____ Diameter ��xb�.�_ Number .____._-__-f____.________ Rock Filled Yes, , No ,0 �WK*C Water Table Depth ------ ------ /1-A �11 Rock Size _ Distance to nearest: Well -l'J�\7_'` _J-_________________Foundation __- Prop. Line .............. l REPAIR/ADDITION(Prev. Sanitation Per Mit# _-__-1- .___---�---- _�) _ _,1f Date ----------------------------------1 Se tic Tank (S ecif Re uirements) .............--5' �a p� p Y qv� f =- ------------------------•---- -- - -- _ Dispas Field (Specify Requirements { - r------------------------- . ,-- -I-------- -, -- � -------------- -- C� --------------------------------------------- ` DrariV existin and re'cured addition onreverse i e---•V�---.L- - ---------•----•------------- I hereby certify that I have prepared this applicatidn and that the work will betdone in accordance with San Joaquin County Ord f"nces,.State laws,.and.Rules-and-Regulations-of-the Son,Joaquin local,Health.District. Home owner or-licen- sed agents signature certifies the following: 1 t�'A ` "fl 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." J _. Signed ---------------------••--------- ----- Owner. BY ---- -- -- i - - Title � �-y------------------ - ------------ (If of er owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ........ DATE .._......'AK - -------------- -- - - BUILDINGPERMIT ISSUED --- -------------------------------------------•---•------•-----••- --------------------------------------DATE ................... ---•------•-•--- ADDITIONAL COMMENTS ----------------------- --------------------------------- .................... --------- -------------------------------- . - ------------------------------------•---------------•------------------------------------------------------- -------•-------------•-------------------- -•-- -1--------------------------------- -- - ---------------------------- ------------------------------------ ............................... ----•------- -------•-•------------••-•-------------- FinalInspection by- ------------- ----------------------------•--------•-------------- -- ----- --------Date --•----------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M