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....... -----• APPLICATION FOR SANITATION PERMIT _ (Complete in Triplicate) Permit No. _.7s._ -��.0 ............... -----------.---------- This Permit Eipires 1 Year From Date Issued Date issued ...7:��5.-.7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ijp(�(/ p ))ce w;}hryrOrd;� re No. 549 and existing Rules and Regulations: JOB AbDRESS/LOCAT CvV I"I ........_.CENSUS TRA "5� Owner's Name __. _ ... .................•---•--------•---------••---....__._...._ _ . . -L. _._... � � Address ------•-- Ci '�-- Contractor's Name ------------------------------------ ------------------- •-• ty ._... ------- ---------••---•------•-•------- ------ -------------- # .. .�--------••---------------------, License ........... .--------- Phone ... ------------------ Installation will serve: Residence ❑ Apartment House f3 Commercial ❑Trailer Court ❑ Motel ❑Other ---------------------•---. -- Number of living units_____________ Number of bedrooms ..... ----.Garbage Grinder ...... Lot Size _...._l ._ '- Water Supply: Public System and name _..._..r4--,� � ��77�,�-� �(-4TS . ..... • - -�-7?.'_b.----...-•----- •-----..Private, ` Chorocter of soil to a depth of 3 feet: Sand Silt CIa Y ❑ ❑ ❑ y ❑ pe [] Sandy Loam ❑ 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 Ilr1STAtLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) . Gf PACKAGE TREATMENT ( ] SEPTIC TANK �� ----------_--- ------ Liquid Depth ...- ��_.___..-_•- Size ...--- Ca Capacity G p ty ... Type ..-r„--'-------- Material---------------------- No. Compartments -------A----- Distance to nearest: Well ---------------•-____-_-------------Foundation -----------------------Prop. Line _._._-_---____---_- LEACHING LINE [ � No. of Lines --------------- Length of each line.__.__��_ _. G��/ -•-----y --- --..._ Total Length ----•�------------------- D' Box -----tit``_°- Type Filter Material ____/_�-'.____ Depth Filter Materia! ___._______- -- ------- , Distance to nearest: Well ..__ � .�___._.__ Foundation ------0_...... property tin ------------------------ SEEPAGE PIT O Depth -------------------- Diameter ---------------- Number ---------------- ------ ------ Rock Filled Yes ❑ No ❑ Water Table Depth ------- --------------------------- ------------Rock Size ----------------- Distance to nearest: Well ---------------•--- -------_------Foundation -------•------------ Prop. Line ....... ---------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date .............. ) ----- Septic Tank (Specify Requirements) _________________ --------•---•----------------•.----------. -------------------------------------•- Disposal Field (Specify Requirements) _---------_ __---------------- ••----•--------- (Draw existing and required addition on reverse side) 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 Sar: Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify th in the pert mane f he work for which this permit is Issued, I shall not employ any person in such manner as to becomes o arkm s nsation laws of California.” Signed -----•------•------- ---- Owner By -----------------------------------------•----------- ------------ ------- ------ Title ---------------- ---••-----------------••------- (I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .............. ' BUILDING PERMIT ISSUED4,A-,- ................•----.... - DATE ----- ------------------------------------ 4f COMMENTS /a._.a �1 .� - -----------DATE _... -----'----------------OIL -- --- ----- Ou - � _� ,_P .� - -- ------ ---•-- _ 54 �`.' '. ..... Final Inspection by: --•----•----••-EH 13 2h 1-68 Rev. 5M ---• ..... .._ -- ------------•----- - Date ----.--__..-----••-- - --- -----•- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT $/7 31M