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FOR OFFIC&USE: FOR SANITATION PERMIT APPLICATION Permit No ue--�-------------------------------- (complete in Triplicate) Date Issued _�1_71---------------------------------- l - I This Permit Expires I Year From bate issued ---- ----- a struct and ins it to con Application is hereby made to theac l hHealth Di tountyOrd nan a Nom549 and existing RulestalndthRegulations- . I described. This application is mad n compliance / f r-._CENSUS TRACT -------------- JOB ADDRESS/LOCATION ------- ----- phone - � �� Owner's Name -" ---- �--- =- ---�� --�-- Q _ ------------- G3' 4 rl- h ---------------- -__. City ----- -- "" 1 Address Ef' ' J� '`'"-'License #�`eva---- Phone f7.�� -"-47 �� ii Contractor's Name --."- � - -- - - - - Installation will serve: Residence Apartment House Commercial ❑Trailer Court -F Motel ❑Other -------------------------------------------- Number of living units:---J_____ Number of bedrooms -_,I----Garbage Grinder _}W----- Lot Size ---__ _"__ '- ------ 1 Private Water Supply: Public System and tname _-----=------------- - = Sand[] j] Clay ❑ Peat El Sandy Loam .0 Clay Loam Character of soil to a depth"of 3 feet: Sand Fill Material - ""_. yes, p ---------------------- I Hardpan E] Adobe (plot Ian, showing size of lot, flotation of system in relation to wells, buildings, etc. must be placed on reverse side.) i' ` NEW t I pis tank or seepage pit permitted if public sewer is available within 200 feet,) INSTALLATION: (No se ' ' Sizp o.- -��--------._ Liquid Depth ----- PACKAGE TREATMENT I ] SEPTIC TANK --- No. Compartments ----" -.---•- Capacity' l-,l( 1,� Type CQ nom'Le�� Material P ` i --- --- 4J Foundation __---/ice---�--- Prop. Line _-- _-- I Distance to nearest: Well ""--"-��---------------- � Length of each line_." -" _ Total Length ------ ------- LEACHING LINE Q�f No. of Lines """ le -- --- / -__De Depth Filter Material ----------" -- --------------------------- 'D' 'D' Box .-_ "F- Type Filter Material ------ •--- P " -"-" -" r � _�_ � �------- Property Li 'e ---��•-----....:_ Distance to nearest: Well --""_.�Q Foundation _"-"-- Diameter _ " - Rock Filled Yes No i❑ SEEPAGE PIT' (�(J Depth �- --- -4 Number - " -----G -Rock Size --------- Water Table Depth -------------- - I � -""-•--Foundation --�>�----•---- Prop. Line ..��----------- I I Distancelto nearest: Well --------e'OV4 ------------------ ----- f REPAIR(ADDITION(Prev. Sanitation Permit# _---------- -Y " Date - ) Septic Tank (Specify Requirements) --_.-_-_----- - - - -- --- ------ - --- -- Disposal Field (Specify Requirements) -------- -----------------------------=------- f ---------------- -------------------------- 1. ------------I--------------------------------------•--------------------------- ----------------------------------- i t (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 i and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws,sed agents signature certifies the following: l "1 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 ----------------------------------------------------- Owner BYJ- = -------------------- -Title �`[ ( {If other than owner) I R DEPARTMENT USE ONLY DATE !Z_--- �-------- -------DATE -------------------------------------•--- ,-" APPLICATION ACCEPTED BY _'_"_ """__"" BUILDING PERMIT ISSUED ----- `---------------------------------- -------------------------------------------------- ---- ADDITIONAL COMMENTS -------`------------- --------- ------------------------------------------------------ -- ------------------------ -------------------------- ------- ---------------- - - ---- ------------------- -------------------- ----------------------------- ------------------------ -- - - ------- ------ --- ----- -------- ------------------ ------ - ----- ..........- - -- - --------------,Date --------- ------ Final Inspection b t SAN JOAQUIN LOCAL HEALTH DISTRICT r F H 9 1-'68 Rev. 5M �"