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-FOR OFFICE USE:APPLICATION FOR SANITATION PERMITPermit No.76-- ----------------------------------- ----------------- F-`$�--- (Complete in Triplicate) -------------------------------- --------------------------------------------- Date Issued + This Permit Expires 1 Year From Date Issued Application is hereby made to the San 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 Rules and Regulation 1 loo _ -------------CENSUS TRACT ---- JOB ADDRESS/LOCATION .- 1 ----- Owner's Name .ice V`�t�--.- = Phone .-sQ35--------- ------ Address -- .- i b0�-------�-----��!Z�ti - -- ------------------------ city ------------------------ -------- ---- -------------- ------ Contractor s Name------F..-- --.License #------------------------ Phone -------------------------•--- 1 - Installation will serve: Residence eApartment House ❑ Commercial ❑Trailer Court ❑ i Motel❑ Other ------.------------------------------------ 11 "0 QQ---KC%eS-------------------- Number of living units: _.__!-- -- Number of bedrooms-�---.--Garbage Grinder .- - __-.___ Lot Size -- ---- -Private Water Supply: Public System and name---------------------------------•------------------------------------------ - :I A 1' I Clay...❑ Peat .❑,,,Sandy LaClay Loam ❑ -� Character_of soil. to_a_de fih of,3 feet .,,Sdnd:[`1 —Silt r Hardpan ❑ Adobe'❑ Fill Material ------------ If yes, type ---------------------------- Ian showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) � (Plot p g �,L,� • NEW INSTALLATION: (No septic tank or -seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK [ ]F� --- Liquid Depth ------------------- i PACKAGE TREATMENT € ] 1��0 �— Size------------------------ -------------- q p ---- F Capacity ----- TYpe `e ------- Materia! �yrcce No. Compartments , Distance{,to nearest: Well------------------------------------Foundation---------------------- Prop: Line -----------••---•--•-- r LEACHING LINE [ ] No. of Lines - Length of each line --------_-- ---------------- Tota! Length ,_�---------•-•- 0 'D' Box .---------- Type Filter Material --------------------Depth Filter Material ---------------------------- �1 I ! , Foundation ----___-- -- Property Line Distance to nearest: Well ----------------- ---------- I Rack Filled Yes ❑ No ❑ SEEPAGE PIT [ ] Depth --------- Diameter t ------------ Number ------------- -- . ----------- ` Distance to nearest: Well -------------- �-----••----Rock Size ------------------------ ------- Water -Table. Depth ------------------------------------ 1Foundation-------------------- Prop. Line ------------------- 111 ---------•--------- I l S ! REPAI DDITIO (Prev. Sanitati 4n Permit #-.----------------------------------------- Date ----------------------------------1 Septic Tank (Specify Requirements) ------------------- ------------------ ----------------------------------------------------------- I d��- Disposal Field (Specify Requirements) -_�-11q'� --------------------------------------- --- ----- --- -- _ --------- ` � ------ � x xJa ` (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 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 sub'�e�to or man's �mp;;�r ws of California." Signed y-- /P r— '�C - f --r------Owner -----------------------title ' ------------------------------- ---------------------- ------------------------------------- (If other than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ --------------------------------------------------- BUILDING PERMIT ISSUED- ---=`� _- ---------------------------------------------------------------------- ADDITIONAL COMMENTS-" ----------- - --- -- -------------- -- -- ---- ----•- ---- - --- - a ---------------------- -------- - ---------- ------ - - -- Final Inspec ------•- E. H. 9 1-'68 Rev. 5M -. DATE --..--k1'-.k-r%'Q---------------- ----DATE-----------------------•------------------ ----- -----------------------------------/------ --------------------------------- ---/ _--__ ---- --------- Date - ,I SAN JOAQUIN LOCAL HEALTH DISTRICT