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FOR &'&ICE USE: APPLICATION FOR SANITATION PERMIT I- Permit No. _`7_/--7._7_� (Complete in Triplicate) - ---------------------------------`- II_ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made fo 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: I� JOB ADDRESS/LOCA ON . . �_3 ' --- ----------CENSUS TRACT --------------A----------- -- - r -------Phone --------------------- -------------- Ow' ner's Name ---- '-/-��'I�-�----=��-."�--- -- ��------------------- Ad�dress ------------------- - I� ---,�- ---_ ---- -- � � --------------. City -_��^ ---------------------------------------=------- Contractor's Name --___ -- 4 a -- License #f�_cl -% --_-- Phone __f� aS/ / - - -------�-F -------------------- - Installation will serve: Residence partment House❑ Commercial ❑Trailer Court i❑ I j i Motel [D Other ___4__?------ ---------- ------ ------ I. A- Number of bedrooms ' Number of living units:_-___ --__Garbage Grinder 1A:_X____-- Lot Size . _m3U'X___ coo--------- " Private Water Supply: Public System and name ______________________________ _ s' Character of soil to a depth of 3 feet: Sand'❑ Silt C) Clay [-] Peat E] Sandy Loam -E] Clay Loam :❑ Hardpan E] Adobe ill MateralLva---- If yes,type --------- ------------------ (PI,ot plan, showing size ofl lot, location of system in relation 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,) / W PAICKAGE TREATMENT [ ] I SEPTIC TANK [ izej___ SX _________________________ Liquid Depth -. ?-___--------- W I Capacity ��- - - Type _� ��-::�IlateFial___ �ht � No. Compartments - --------- -- -- tance to nearest: Well --------- ------ ------------l-----Foundation ----1/d----------- Prop. Line ��_.-- - � s f g / a --------- --------- Len ` _ h l ne.- ---j_------ -- Total Len th LEACHING LINE No.. of Lines Length o each � ' -- D �1 oxfto 41) Type Filter Material -__Depth Filter Material ----- y_�__________ r___ Foun¢ , Q Distant nearest. Well --------��----. dation /---------------- ___ Property Lime- _______.________-..___-- f ,/ e Depth �--------- Diameter .... --- N l be ock Size _ _J%z Rock Filled Yes 2---No SEEPAGE PIT [a,� De i' � Water Table Depth --------- ---•- ----__ _ 1 Distance to nearest: Well ------/P_6 -=-`=-' Foundation ---- ------ Prop. Line .. -------j___. .-•- lM � Date ----------------------------------) ------- REPAIR/ADDITION(Prev. Sanitation Permit#.____________________________ ----- � . Septic Tank (Specify Requirements) _____ --------------- -- -`------- =' -----------------------•---- Disposal Field (Specify Requirements) -----------7-------�---- _` a • -------------------------------------------- - ---------------------------------------------------------------------------------------------- -- �-- -,.,.,(.Draw existing,and_r-equire8.addition_on reverse side) 1 hereby certify that have prepared this application and it 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 "Iicertify 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 Ciftlifornici." C4 I� A !' Signed ---------------------k_: ---------- --------------------------------------- ----- Owner i_._ Lc`' BY ------ �T ,r,_- ------- -------------------- (lf other:t n. wned II FOR DEPARTMENT USE ONLY I� p , APPLICATION ACCEPTED BY 144&- - ----- ------------------------------ ---------- DATE l "7 ------------------- BUILDING PERMIT ISSUED ll:---------- [ DATE ------------------------------------------- -- --------------------------------------------------------------------------------- ADDITIONALCOMMENTS A(--------- -� -'. :w; == ` = '--------------------------------------------------------- --"-------------------- ----------------- --------- -13. - Rh - ------------------------ i[ - ---------------------------------------------------- i ii ---------- '�i f ' ----- -- ---------- ---------------"------------------- -- - _iH _ ______- _._. ___ _ _____ Final inspection by: --- Date ---/f-' f = SAN JOAQUIN LOCAL HEALTViLOISTRICT i E,!H. 9 1-'68 Rev. 5M _ r