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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ----------- - Permit No. .��—.��3/ l� (Complete in Triplicate) - - ----- �1 �' Date Issued _/�............' __._________.-.._-._-____________- ------------- This Permit Expires 1 Year From Date Issued Application is hereby 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: JOB ADDRESS/LOCATION, A�_r G1R$,,v_,,l,,N//___ ____-__1 v7__._Z_�.Z-----CENSUS TRACT Owner's Name .-------/c?-1 �+ k--- ---------7Y �'��C ------------------- -----------------•---------- -Phone --------------------------------•--- Address ---- 31rj 0_e -0-----H_41-xoty------ ------------ ------------------- city _,'m Contractor's Name _-a4 XTA_oW ------ 4,fV---__---__---___________.License # _�d�''�'rg6-- Phones_�_-'�--.--y ....... . Installation will serve: Residence 'Apartment House❑ Commercial ❑Trailer Court ;❑ •J� Motel ❑Other -----------•------------------------ ------ Number of living units:----/----- Number of bedrooms _-_.,/-:'..Garbage Grinder _AA__ Lot Size ---------------------- Water Supply: Public System and name -------- `�' � R'C'---------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silto_ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam_X Hardpan ❑ Adobe ❑ Fill Material ---- -_-_- If yes,type ___________________________ (Plot plan, showing size of lot, location of sy�intion to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepmitted if public sewer is avail in 200 feet,) Aill PACKAGE TREATMENT [ ] SEPTIC TANK[ Size...... X1 _ ___X__ -----____ Liquid Depth ----L.�........_... Capacity 1400G,A4-'hype,rbra__6f7 Material----CV Wc-jo___ No. Compartments A................. istance to nearest: Well ________________________-_.-----Foundation ------f®..__.____ Prop. Line ....54_............. LEACHING LINE [ No. of Lines 41 — Length of each l ine_13 X- _3-.-_-_ Total Length 'D' Box ----/----- Type Filter--Material _ AV&.-Dep* ,iter Material Distance to nearest: Well ________________________ Foundation _.T.'t_-__ --__ Property Line _.__� ............. SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ No I❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- 0 Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... P REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) C1 Septic Tank (Specify Requirements) ----- ---------------------------------------------------------------------------- ---------------------------- ------ J Disposal Field (Specify Requirements) .��_-6__ ,1�---------------- --- ------------------------------------------14 ----------------------- fQ aA1V.?'rh0A1------AMAKe-'D--------0-t1-7_ bV_T_-__w,0.7_......P4�e13.M fi ------------------ ---------------------------- -------------------------------- ------ 'T� 4 -------------------- (Draw existing and required addition on reverse side) F 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------ A'rnp ®/ --------------------------------------- Owner A By ------------ --- Title ----------------- ------------------ ---------- -------------_- -=- (If other tha ) � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ______ __J --- -- ------------------------ _-_-. DATE ..... ._._._ ` BUILDING PERMIT ISSUED ---- --------------------------------------DATE ----------_-.---------- _--- _ ADDITIONALCOMMENTS ---------- -------------------------------- -- _ ------------------------------------------------------------------------ -------------------------------------- ----------- ---------------- --- ------ -- ---------------------------------------------•--------------------------------------------------- ----------------------------------- ---------- ------------------ ------- -j ------ ----------------- ------------------- ---- ----- ----- {_ Final Inspects Date ----- - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M