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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT r /-¢� Permit No. .....w,..,.r--�v. . ,..... --- �-. .._ 1 -(Complete in Triplicate) -------------------------------- ' Date Issued This Permit Expires res 1 Year From Date Issued Application is hereby made to the an 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 Mules and Regulations: JOB: ADDRESS/LOCATION ."__--- ��--261 j---E._ -- --Main---------- ---------------CENSUS TRACT ------------------------ Owner's Name _PS.u18.-_RaMQS----------------------------------------------------------- Stkn. Phone Address dame City -------------------------------------------------------------•----•- ------- - Name Blacka3ZgV.SIS-pptic---Tank--"C__v-,_----_---:---------License # _268.95_1------- Phone _63�7Q�$------- Installation will serve: Residences Apartment House[] Commercial ❑Trailer Court -,E] Motel 0 Other ------------- ---------------------- Number of living units:l._ --._ Number of bedrooms ---2 _--=Garbage Grinder ------------ Lot Size -.-5a f X----- �-�-------------------- Water Supply: PublicSystem and name ---------------------CitY----------------------------- - Private ❑ . Character of soil to a depth of 3 feet Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:C] 1Hardpan ❑ Adobe fU"FiII-Mcifierial ___-"" ----If Yes, type ------------------•--------- (Plot`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 public sewer is available within 200 feet,l _..TIi _ K Liquid Depth -------------- ----- ----- PACKAGE TREATMENT [ ] SEPT1�TANK`[ ] r Size------------------------------------ --- ----Material---------------------- No. Compartments -----:•------ r Capacit - Type ------- Distance to nearest: Well -- ----------------------------- ---Foundation --------- ------------ Prop. Line -----------•--.------- LEACHING LINE ( I No; of .Lines ------------------ ----- Length of each line------------------- -------- Total Length -------------------- ------- + „ 'D''Box ___ -- Type Filter Material --------------------Depth Filter.Material ---------------------------------'•----••- ' % Distance to nearest: Well -----#-----------------= Foundation ------------------------- Property Line -----------------..=---- DepthDe "_'10_s--�, __- Diameter _4_'_X10"` Number --------1------'---------- Rock Filled Yes K] No �❑ Sump. Water-Table- Depthl-------- 9 �t-------------------------------Rock Size ---------2s----------- �" Distance to,nearest: Well -------------- —..—.. -----------Foundation -__1_5_+----------- Prop. Line --.5-r----=-------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------- ------ Date ---------------------_-------- t Septic Tank (Specify Requirements) -------------------------------------------------------------------------------------------------------•-----------------------------,-------- Disposal Field (Specify, Requirements) --------------- ----------------------------------------------------- ------------- ----------------------------'---"--------�:_- -------------�--- --------------------------------- ------- --- a ' - � _, raw ea istl cation and `red a h tion -- -- } " j ( g q addition on reverse.side) s I hereby certify that I have prepared pp a work will be done,in` accordance with San Joaquin i 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' riof eFnploy'any person in such manner as to become subject•toT Workman's Comp ne cation laws of California." T-� Signed---------=- ------=---------- -- ----- ----- --- ------------------- ---- --------_.Owner - - - -_p Title ----------- contractor �l�'f-�--- ----- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ---------------------- �� DATE .-. BUILDING PERMIT ISSUED '------ ------DATE ------------------------------------------- . ------------------- u } ADDITIONAL COMMENTS ---------- ---------------------- - ------------ ------ - i ----------------------------------------------------- ------------------------ i ----------------------------------=-------- i ------------------------------------------ -------------------------------------------------------- ------- t - - -- Final Inspection by: "-_-- ""- Date ---------- �_r `3 ----- SAN JOAQUIN LOCAL HEALTH DISTRICT co E. H. 9 1-'68 Rev. 5M