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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /v s r� Permit No: 74�:7 •-•.--_.T (Complete in Triplicate) ...... y..ov�...... ...`�.�... �"'........ pate Issued � ........ I Z Zo J76 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: I ( e-- ...Vlt. ..CENSUS TRACT .............•............ ..� - ........... ............. .... JOB ADDRESS/LOC ION ....5'�._ w. O -•--•.Phone Owner's Name Address ... ��/..�..... ........ ........••--._.... __.._. :.... City Phon .. �1.......... r t Contractor's Name / ,�� --�..7 +•-: --.. i_ ._ _C1l�l1i- -- ....................License # 3Gl ..lr--- . -- -• Installation will serve: Residence/'Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ................:: •--•-...........::.... / r_, ....r......_.... Number of living units:- Number of bedrooms _3--..Garbage Grinder ..Xle Lot.Size ... _. .. ._. Water Supply: Public System and name ................ ...... .....................•••..-Priya ❑ s� ------ to I Peat. . Loam Clay loam ❑ Character of soil to a depth of 3 feet: Sand❑ ..Silt❑ Clay ❑ ❑ 'Sandy Hardpan ❑ Adobe ❑ Fill Maferiol ............ If yes.type .-------- (Plot plan, showing sire 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 public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] ] -• • Liquid Depth .......................... SE1sTIC TANK � Size. .. �- -� i Material__ lAl .004 No. Compartments .._7-.-f•--- -•• Capacity/.�C... . ..... TYpe �� ti � Distance •-• to nearest: Well ../.dd.-.� ........--..Foundation ..�11••-••........ Prop. line . CJ.---.•---.. , No. of lines Length of each line.-._. . ae'Total Length _.. -.. _. LEACHING LINE ( ] ... . ...........�j__-.. r 'D' Box ........:..- Type Filter Material -- ..::..._#- Depth Filter Material ........................................ Foundation . .... Property Line --- -.��..------..:• Distance to nearest: Well ..� -.:-•.-- •- •-•••----- SEEPAGE PIT [ ) Depth _-- ...... Diameter'=.t.............. Number. ......._.. ......... Rock Filled Yes 0 No [� ' Water Table Depth ......Rock Size ........I...................... .................5......_............ ..Foundation -_._... Prop. line ...................... Distance to nearest: Well- ................ ••-'----"•'- • i * REPAIR/ADDITION Prev. Sanitation Permit# Date ..........:.......................} 1 , Septic Tank (Specify Requiremants) ------••-•...................................---............................................................I...................... -----•--- Disposal Field (Specify Requirements) _..---...._ ......................•....-------..... = ... -----•---.. tri.,--- --•-•-......._.,-..,.M:..........................••--....._....-------••--••-- P (Draw existing arid.required,addition on reverse side) P I hereby certify that I have prepared this application lication and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and"Regulotions 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 parson in such manner as to become subject to Workman's Compensation'laws of California." Signe -- ------------•--- ---••••.............................................. .. Owner = - Title:. .. .................................. .. _ �'��. I By ( other than owner} FOR DEPARTMENT USE ONLY ..,•---:.....•.......................•---_.... DATE ...1 .' 7 l APPLICATION ACCEPTED 8Y ,_ LGA`-- ...- - ..... . .... ........DATE ................................... BUILDING PERMIT ISSUED ADDITIONAL COMMENTS ' .......I....... .................... i ..._1 .1.....I....... .:._.. -- -------••....... ...... �!• D .................. Final inspection by: ._1 ._ ...............................................••-•------ . � ate ...... .,'SAN J AQUIN LOCAL HEALTH DISTRICT w M 7/72 3 M c 13 24,_'.co De.. 4AA