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---------------FOR- --OFFICE- -USE: APPLICATION FOR SANITATION PERMIT ---- - -- -------- •- (Complete in Triplicate) Permit No. __74/7 ------ Date Issued ...lr a-3 7� ------------------__-_--_-._------.--____..._-_------_ This Permit Expires 1 Year From bate Issued _.-� . ._..._. ... Application is hereby made to the San Joaquin Local Health District for a per 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 .---SAN----.J4r9_g'_&dw--------Rei.-V-r,--y------C-_L,_1'--------- ----CENSUS TRACT _----------- Owner's Name ------13c-V je_X- i4y------- -----&T C-4 ---------------------------------------------------------------Phone ------------------------------------ Address _ e7000 hjl S a u d `3 city Y G / Contractor's Name __ __/�J.vI-/4� y__-'1�---�N--------------------------License #4_6'�--- Phone ........... Installation will-serve: Residence X Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:_-_-/__..-. Number of bedrooms ----- ....Garbage Grinder - ---------- Lot Size �p Water Supply: Public System and name --------- �� ------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam K Hardpan ❑ Adobe ❑ Fill Material --------- _ If yes,type -.------.-.._--._.----.--- (Pl'ot plan, showing size of 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 ublic sewer is available within 200 feet,) f PACKAGE TREATMENT [ ] SEPTIC TANK:K Size----- i�_X._ -..---.._. Liquid Depth __70---------------- Capacity /ZOo-4Ai Type 10jYC_C;s7_Material---jC 'Mc-----. No. Compartments -.--2................ Distance to nearest: Well ---_-.-__-- f f i ----------------------Foundation -------0---TT--------��-jjPr . Line -- ......... LEACHING LINE [ ] No. of Lines --------------_-..--..- Length of each line/y �_ _ � 'Total"Length .----------..--•------_---. Fri-Mp , 'D' Box ---/------ Type Filter Material --------------------Depth Filter Material -------------------------------------------- f3 P, .......----..----.---.--.----------,.-_---.f3l;fl Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ........................ SEEPAGE PIT [ ) Depth -------------------- Diameter --- ------------ Number ---------------------------- Rock Filled Yes ❑ No Water, Table Depth ---------------------_- .......................Rock Size -------------------------.------ 111110- Distance to nearest: Well ----------------------------------------Foundation ------------------- Prop. Line .................. ... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -----.-•----------.---•.---•-_.---) SepticTank (Specify Requirements) ------------------- -------------------------------------------------------------- ---------------------------------------------------------- DisposalField (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ----------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------...------ (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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed-i9kr/4�ssu > "f--SoN------------------- -------------- Owner -- --- -------�---------------------------------------------- Title -------------- ------------ --------------- -------------------� (If other tha owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- 11�k--------------------------------------------- ------------- DATE -----`1�- ---------- BUILDING PERMIT ISSUED ------------------------------ -------DATE ------------------------------------------ ADDITIONALCOMMENTS ------------ ------------------------------- ---------------------------------------------------------------------------------...-------- -----------_---- -------------------------------------- - --- -- ------------------- - ------- - - ------------------------------------------------------------------------------------------------------------ ------------------------------------- --------- ----------------- - ------- ---- ----------------------------------------------------------------------------------------------------- ---- ----------------------------------- --- --- -- -- --- --- -- -- --- - -•--- ------------------------------------------------------- _ Final Inspecti �`�------ ----- ---•------------------------------- ----Date ---- ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M