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U---Oc FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT JJ y ----------------- Permit No. -.G�--F------- -4 iComplete in Triplicate) ---------=------•---------------------------------------- Date Issued 1e--,a� , _----&I This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 1 JOB ADDRESS/LOCATION ._ - '----___ r_ L ' r• r/ --t�J ar ........CENSUS TRACT ----..?--7 Owner's Name ------Pie&e..... ------- �.3 —2_2 .2 -- - - - - - - - --------- ---Phone ------ -=- ---- •�---'�------- C �.. / k �,. -r- •� __/-- ------------------------------------------------- Contractor's ------------- Address ---°��---'�-- �-,.�-,!� � - �'�- --'�'� -- -~ -�---------------------- City -�-�----- � - --- -------- --------------•------ Contractor's Name ' ''� `�f/ -----.License # - `x� � Phone 47' --. -1/- `F-- ._ Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other -------------- -----------------------••--- Number of living units:---f------- Number of bedrooms _________Garbage Grinder �------ Lot Size ___ { ______________..... Water Supply: Public System and name ---------------------------------------------------------------------- ---------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loom 'N Clay Loam ❑ pp Hardpan ❑ Adobe ❑ Fill Material -------------If-yes, type ___________________ (plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) %,D NEW INSTALLATION: (No septic tank or seepage pit permitted if„public sewer is available within 200 feet,) w r PACKAGE TREATMENT [ 7 SEPTIC TANK:[ J Size---------------------------------- ----------- Liquid Depth -.--- �apacitY -- ------------ Type -------------------- Material-------------------f-- No. Compartments ---------- T), 'Distance to nearest: Well ----------- ------------------------Foundation s- Prop. Line ----------------.____-_ LEACHING LINE [ J No. of Lines --------------- ---------- Length .of each line-------------------;.------- Total Length f,---------.____ . i 'D' Box -----.------"Type Filter Material --------------------Depth Filter. Material -------------------------------------------- Distance to nearest:`Well ------------------------ Foundation ------------ ---------- Property Line -------•------ -------- SEEPAGE PIT [ j Depth ____________ __- .Diameter ____ ___________ Number _-_----..----._F---------- Rock Filled Yes ❑ No i❑ Water Table Depth -------------------- ------- --------- Rock Size == r � Distance to nearest: Well ----------------------------------------Foundation --------------- Prop. Line -------------- ....... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- DateI__________________________________) t Septic Tank (Specify Requirements) -----------------------------:--•b--------------------- =_--------------------------------------------------•..--------------------------- Disposal Field (Specify Requirements) ---- _ yc i - C' ' 'c lr " �' lx�� ,:-'--�,�x'�-r _ _ - ----------- ' ''�/'.,� � ` ;✓ '`E JXI_ST!_1�ff- -.-TAN_K-------pump-v_- ---- KFS ZJ) --------ae-- ------p8arRA----- cont«-.....r1q )�-----1N� Tt1 � R �� r F SM ------F0LlNDA7LQW/ -- - »r (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 So Joaquin 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 not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----t"--------------------------- ---r----:"--- x'--` ------ Owner Y �- ___ Title ,,.;,,r�•�.,.., (If other than owner) �— 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY P�'r � ----------------- DATEr �f.7--• T BUILDING PERMIT ISSUED -------------------- - ----------------------------------------------------------------------------------------DATE -------------•----- ----------------------- OMMENTS - --- ---ADDITIONAL C ------ - - - ----------- ---- -------------------------- ------------ ------------------------------_-_-_-----------�--�--------------------------------- -- - -------------------------------------------- Final ----------------- -- -- - Final Inspection -----------------------------Date -----� -' - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M