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0R.OFFIC12' USE. APPLICATION FOR SANITATION PERMIT r - Permit No. -41/51-f -------------------------------------------------------------------------------- --- ----------------- -4 f ! (Complete in Triplicate) t -------------------------- f �.( Date Issued i +J This Permit Expires I Year From Date Issued yN.A. te, q,, '-'L t teelt D-i'J`+I nam No 549 a d exi ------- ------------------ --------------- + ict l the work Application is here made to the San Joa uin Locc(i Health Dastnct for permit to canstr "Sting nRules tand Regulations:e�n described. This application is made in compliance with Counjtyi'Ord s j . �,Bl;?�'I✓104�--- ----- ------ --------- -------- ----CENSUS TRACT -------------------------- JOB --- --------•---------.. JOB ADDRESS/LOCATION .--.-- 2-.- ., 4� - Owner's Name --- A�i_l?"e�---�D- ----- :- ---- - -------------- Phone � Z Y------------------ --- _ - _. 1`�4eU_R -,_ L.�___ -----•- city ' 1 - Address .-. t 'il ,- - _ _ . 434 Q(o�o" �84 q -- , . a ---- Phone " �-----------�-----. Contractor's NametAY--I--�_ - - License # - -- --- • ,k 7 *-• Installation will serve: .Resi'dence. Apartiren#"hlTuse❑ Commeri:ial .[]Trakler Cour` ',❑ _° _ _�„ �_ �,a 7�i/lote ❑Other _ :_. l 1a® �[ 15n Number of living units:--_�------ Number of bedrooms-4--Z---Garbage Grinder - .0 Lot Size I CA�� -� " "" _Pr Private ❑ -t�_._- Peat SQndy Loam Water Supply: Public System and nam -__-~- --� �---• - '�-��--�� -- --------- - " Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ ❑ ° If yes, typ Clay Loam 'D ° y Ha�dpan ❑ Adobe Fill Material _ ----------------------"----- t a, x 1 t a s t {Plot plan, showi.n'F size of lot, location of system in ' buildings, .etch must be placed on reverse side.) g y i NEW INSTALLATION: (No septic.1tank'' or seepage pit permitted if public sewer is ava.raable�within 20d feet,) d '� PACKAGE TREATMENT [ ] SEPTICSize._ :_:. _ ------�---- "_ p Liquid Depth � Capacity Type Material Compartments ------ •--= Py ---------------- Distance to nearest: Well ------------------------------------Foundation ----------- ---------- Prop. Line .-----•---_-----._---- 17ota �Length- ~Length of •---- " T; FilterNla ' _. 'D Box - yPe' Fit x`_x- `-? Pt _ ----- --- 9.. __�.. .: .__ _ _�,, ,.......-,..^W~..�.♦W-.__".".r" Property Line. Distance to nearest: Well ___-------------------- Foundation .__ -_._ __ p Ii Depth No SEEPAGE PIT - ---- - - ----- Diameter -------------- Number ---------------------------- Rock Filled Yes 0 Water Table Depth Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------------- I Date ------------------------------ REPAIR/ADDITION{Prev. Sanitatioin Permit# -------------------------------------------- Septic Tank (Specify Requirements) ------------------ ------------------------ �D ------------------------- ab ------------------------------ D 8 1�© In ei.Z-pri-------L�-'1--------------------------- Disposal Field (Specify Requirements} - ..-__-_® -----• 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 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 "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 ------------------ Owner - ------- --------- --------------------------------- - 1 ---------- Title i"i - "----------- ---------------------------- (if other than owner) I FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ---- ' -------------- --- -------------------------------------------- - DATE �` '��DATE - BUILDING PERMIT ISSUED --------'A--------------------------------- ------ iADDITIONAL COMMENTS ----------1--- --------------------------------------------------------------------------------------- -------------- - -• -- ------- - ------------ ---- ---------------------------- --- ------------- - ------- ------------ ----------------------------------------------------------------------- -------------- i ---- ------------------------------------- .Date -..----- -- Final Inspection by: --- --------------------------- ---- ---------- ------ - i I SAN JOAQUIN LOCAL HEALTH DISTRICT t E. H. 9 1-'68 Rev. 5M.