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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .:�' ... (Complete in Triplicate) - --------- / 76 r 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 rand install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. [ ?5 �A-( r-.? ..S-`7-`{ JOB ADDRESS/LOCATION .. -4 D woe-,e W-f�1��A_�NSUS TRACT .......................... Owner's Name ---77... �...eZ6-7,V ............... ? ' ............... (' Phone 'r-- . __� ........ 7 ..- .. Address .-..._��,Zl�---. ...._....- -..-- :, -------------- City/ . Contractor's Name Phone . .-•��4 Installation will serve: Residence-[ (-Apartment-House0-•Commercial-❑Trailer-Court-fD--- ; Motel ❑Other ------ --------------- ------ -- 4C Number of living units,.._..-. Number of bedrooms -._.___Garbage Grinder, ........-. . Lot Size ............................................ i Water Supply: Public System and name ............................... ........-_.------------------------------------------------------------Private i [ Character of soil to a depth of 3 feet: Sand'❑ Silt[D Silt ❑ Peat❑ Sandy Loam 1W Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material -.-....--.-- lfiyes, type :..: ................ Uj .... ` �� (Plot plan, showing size of lot, location of system in relation to wells, buildings,�etc.l must be placed on reverse side.) .''. NEW INSTALLATION: (No septic tank or seepage pit permitted if public.sewer is dvaiI66'1e within,200 feet,) i PACKAGE TREATMENT [ I SEPTIC TANK[ ] Size.---_sXrl A�'� u _t._._. _. Liquid Depth ........... p A � c�...... .. N Capacity / ------ Typep��;'?7 Material-.. ' ' Not Compartments .. Distance` to-nearest. Well .14 ... .--_--_Foundat,ion/. Prop, line ... ............... �, LEACHING LINE No, of Lines Length of each line4".�. _o '.�`�festal LengthC?................. Z 1Type �i�'D' Box Filter~Matenal--�-./!�',��- lie ih Filter^~It+latenal �`�. . ...........................•._-- (� - Distance to nearest: Well ��......- Foundation c rty Line .<17................ SE ERl GEiPIT -f;.1 Depth ameter --------------- Number ...----:.............I...... Rock Filled Yes ❑ No 0� Water Table Depth .... --.---•----------.- ��_Rock Size -------------------------------- - t Distance to nearest. Well _•..__•._._.__.-I-•---------------------FoundptFon___,!................ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# �� y------------------- Date .................................. F ' Septic Tank;(Specify Requirements) ............................... ............................................................ Disposal Field (Specify Requirements[ ..- }.... ......... .. - - --- ... •.. ------- ...... ....._,........... ............ ---•-- -------------------------! .i...... ............. ---------•---.- - ------ ------------------- . ................... (Drdw 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 owher or licen- sed agents signature certifies the following: w "I certify that in the performance of the work for-�vhich this permit is issued, I shall not employ any person in such manner as to become subject o Workman s Compensation laws'of California." Signed ......�>L' ;,. .t �_�.- --------------------------------R_,_....----------------- Owner By .... .. ,{.'..... r Title ..... .. ........................ .........? -- ............--_.._.. (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION !ACCEPTED BY .-.......J :. ' rr +., . .[.................... ................ ------ ----------- DATE . . BUILDING-.PERMIT-ISSUED..•- a f DATE- : ............ : .....-._ ADDITIONAL COMMENTS ._. .. ................ ::............4�.. ._..... _ ...._........._.._ ------------- -------------------- M - - ----------- ........... • ....... - Final Inspection by: ....---- ---- . . ..u- ---------------• ---_-... ------...__......----...-. -Date ... .. b. I USAN JOAQUIN LOCAL HEALTH DISTRICT F. I•I. 13 24 1-'68 R.v_ SM • . 7