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_ -FOR OFFICE'USE: APPLICATION FOR SANITATION PERMIT '�"- ---------------= --''"'� Permit No- 7°-_-- �- ' �X/ (Complete in Triplicate) """ ` 6. / ` ��'� Date Issued -�-_yOr- - - -------------------------- Application -------------------- ---- This Permit Expires ] Year From bate Issued Application is hereby made to the San Joaquin Local Health District'for a permit;to co tructland install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ---M—LrT&e)ZP— '----- *sE----- P_P, 2_A ------------- TRACT -------------------------- Owner's Name _ -. Phone -- a N ;U P_T---------------------------------t-- - ------------------ ��o�pl ' Cit --- 4 ------ Address �24----------------------------------------- ----LN ---------•--• � Y -- - ` --------License# �c1C15' � Phone .4Eln' Contractor s Name .--Y__�r�.�QJS-- __-_-- '�tC--'-------•---------------- Installation will serve: ResidenceX Apartment.House,❑ Commercial:❑Trailer Court ;❑ + , Motel ❑Other _._i____.___ ° Number of living units:___ __ Number of bed rooms•__- ____Garbage Grinder _YES_ Lot Size _��-_-x--r7'�------------------ I � --------------------Private Water Supply: Public System and name ---------'-------=----- ---------------- ----------------- --- -----•---------- ------ I Character of soil to a depth of 3 feet: Sand'[] Silt Clay❑ ❑ Peat❑ Sandy Loam ❑ Clay Loam ID I Y f Hardpan ❑ Adobe;K, 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) !1 ,yR / w[[r .1� /2AQ_G'a4: tE,�!C� Liquid Depth - SZ--------.----- PACKAGE TREATMENT SEPTIC TANK' �c Size` Z _- ,A.-- T e ____________ ___ _ Material ��KC �� No. Compartments ___-r _ Capacity _ Yp T E T ' Distance to nearest: Well --------1�Q�---------------Foundation -- ------ I Prop. Line -_---- - FF 16,0 x LEACHING LINE [ ] No. of Lines -i--tAe�-___.___- Length of act line__--____7�- - -----.___ Total Length j1f____-- G 'D' BOX.f___ ---- Type Filter Material --- epth Filter Material --------------------.-------------- ' Distance�tc nearest: Well ------ -------- �i�_ Foundation ______//--_-_--____ Property Line ________________________ SEEPAGE PIT [ ] Depth t-25------ Diameter -- - - Number ----------i._0--1---#- Ro� gil d Yes No ❑ Water Table Depth % �� ---Rock Size ----ta... 2 / i /ZS ----- '� Distarice to nearest: Well --------------------- ------------------Foundation24:9_.___.___ Prop. Line __..___ ________.- I -) REPAIR/ADDITION(Prev. Sanitation Permi## ---------------------------- ------------- Date --------------_------------------ 1 Septic Tank (Specify Requirements) ---------'-------------------------------------------r---------------------------------------------------------------- ----------------- r Disposal Field (Specify Requirements) ----------- ------------------------------------------------------------ --------------------------------------------- --------------- } ------------------------------------- --------------------------- ------------------------------- 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 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: ; t "I Certify that in Cha 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 Com sa ion laws of.California." Signed �--�- - --- --------�� - ----------- Owner B "^ 4 -- --------------- y /�( --- Title U -- I r other than owner ' "' • 'r ` FOR DEPARTMENT USE ONLY • APPLICATION ACCEPTED BY ---- __- ------------------------------------------` DATE -��----- -- -------------- BUILDING PERMIT ISSUED ---- -----' ---------------- ------------------ -------DATE ------------------------------------------- ADDITIONAL COMMENTS'--" --- _ -- -- C-- ' ------------------ --- -- - -- ---------- -- - ----------------------------------------------------------------------------- -------------------------------------------------------------------------- ----------== ---------------- } p - ------------------------------------------- ____________________ I _________________ _ _ ___ ------ Final Inspection by: `__ ___-_-___------------------- ------------___-___.___________ -------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M