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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT ------------------- - Permit No. (Complete in Triplicate) 7?,_:12J ------------------------------------------ This Permit Expires 1 Year From Date Issued 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 AbDRESS/LOCA710N ___--ay 1/579F------_LC�NET.RE._F ______-_-____-------CENSUS TRACT -----� -- -_-• Owner's Name --------I------------------------------ ----------------------------------------------- ------------------- -------------------------------•-- Address \.: - Qli_ 5-1-- E -----------------. City ------F�oq_,Larj-----------------------------------•------ Contractor's Name UN-DERGRON-D-----UTT-L'fTl'5_ -----------License # ------------------------ Phone -----------_----------•- Installation will serve's /-&=.-E ResldelSnc E Apartment_HouseiECommercial :❑Trailer Court ;❑ I T �� a irE►1 i'r eft Motel ❑Other f---------- Number of living units------/-__ Number of bedrooms - Garbage; GrinderJN�__ Lot Size ---/7 CJ41E/ - ---------- Water ___-____ s i r . _ _ ._ _.-. _..- --- — --- __ - .a .. , J Water Supply: Public System and name ------------ =------ -- - --------------------------------------------------- --------------------------- --- -.Private �� ti Character of soil to a depth of 3 feet: Sand'❑ Sil ❑_ Clay ❑ Peat❑ Sandy Loam ❑ Clay LoamT- Hardpan Adobe ❑ Fill Material __ Q: If yes,�yl?e _4=_'_____________________ (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc. .rnust be placed on reverse side.) NEW INSTALLATION: {No septic tank or see age pit permitted 'if public sewer is available.within 200 feet,) k PACKAGE TREATMENT [ ] SEPTIC TANK [ ] Size---i ------- Liquid Depth ------------------ Capacity --------= _ Ca acit .. P Y ------------ ----- Type --------------- -- Mafierial---------------- --- No. Compartments ------------- �`-�a��. Distance to nearest: Well ------------------------------------Foundation ----------- --------- Prop. Line ---------------------- LEACHING LINE [ j No. of Lines I ----- ------ - =----- Length of each fine-------------- - - - - tal Length -------------------------•-- 'D' Box ------------ Typ Filter Material ____________________Depth Filter Mater al ______-____--__-____________-_-•----_-_____ Distance to nearest: ell _-____________---�____ Foundation __________________---- . Property._Line _______•_...____-___-___ SEEPAGE PIT [ ] Depth -------------------- Diameter ---------------- Number --------------------------- Rock Filled Yes ❑ No Water Table Depth ---- Rock 5i a `3 h(i I `ate- Distance to nearest: I ;--------------------- Foundation_ �'� '_aJ Poop. Line ..:-----------•--•---- REPAIR/ADDITION(Prev. Sanitation PeemitT# '--------------------------------- --- Date ---------------------- --------- Septic Tank (Specify Requirements) ----\------------ -------------------------------- ------------------------------I----------------------------- Disposal Field (Specify Requirements} _/� Ifit�---- - II-C-------I------------- t5T-- -1"3_(,7_X--------------- �. r ' 11�'E-------T ------- = __� _ PA-<:E_-- 1>I X -------------- -----------------------_--- (Draw existing and required additipn 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 sig ature certifies the following: "I certify tho in thV manc the work for whi�ch'this permit is issued, I shall not employ any person in such manner as to beco sub)eorkma Compensation laws,of California." Signe ------ Owner -------- ---- BY ------------------------------------------- -- Jr (If other than owner) ------ _ -?`V' Title ------ -----------------------------I----------------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --T ----•----------------------------------------------------- -----------. DATE ---- �z= BUILDING .P-ERMIL_1.S5.UED _- -------------__7---- --------------------------------------- ADDITIONAL COMMENTS ------------- --- ------------------ --------------------------- -------------------------- :1 y , -------- ------------------- -- - - - -- -- - - - - -- ------ -- ----- ----------------- ----- ----- ---- -- --------------------- Final -= ' Inspe --- ----- - ------ --------- --------------------Date _..._. --�-- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M