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FUR OFFICE USE: vr APPLICATION FOR SANITATION PERMIT --------- ---- (Complete in Triplicate)' Permit No.174- This Permit Expires 1 Year From Date Issued ------------------ -------------------------------------------- -----------—------------------- --- -- Date Issued Application is hereby made to the San Joaquin local Health District for aT ermit to construct ad inse work h described. This application is made in compliance with County Ordinance No. 549 and ex st ngnRulestalndt Regulations:rein } , �y / ENSUS TJOB ADDRESS/LOCATION'/ dr � a ---o _ld }__. _ �R ------ e Owner's Namef a �f. 1 - --_-- ----------- - ---Phone --------------------- Address -------------------- ----- L. Y clC_ ----Cit ----- __ _ Contractor's Name �___"- - �! _____- License #�_ . - Y-39 -�_ Phone . - :+- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other -_e/Ii�l?-gfi Number of living units:------------ Number of bedrooms ------------Garbage Grinder :.______ -- Lot SizeU Y Water SuPPfY� Public System and name I -------Private"WTaracter N of soil to a depth of 3 feet: Sand.�❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe F Fill Material ------------ If yes, type ------------------ ------ 4 (Plot plan, showing size of loft, 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 #eet,J PACKAGE TREATMENT [ ] SEPTIC TANK [ l Size- Material `�a Liquid Depth _-- --ai Capacity /1*5 Type a " (�`� =--------- o. Compartments _- istance to nearest: Well -___'a __._:------•------------Foundation f' f LEACHING LINE ? ------ Prop. Lin ----- I - ] No. of Lines --- ------ - ------_ - Length of each line---' ---- ----- Total Length -----7p. D' Box ----IType Filter Material Rlog Depth 'FilterMaterial _.fes""- .- Distance to nearest: Well _ /p ,_,� Foundation Property Line _ea-_- EPAGE PIT [ ] Depth __. _ ------------ P - -�— - Diameter _ R-_----- Number ----- Z-------------- Rock Filled Yes .� No i❑ Water Table Depth �`" -Rock Size n ------- : Prop. Line ---------_---------- REPAIR/ADDITION � Distance to nearest: Well -___________________ _ _ __ Foundation - ----- --- --c (Prev. Sanitation Permit�# ----------------------------- --------- Date I , Septic Tank (Specify Requirements) Disposal ''- -------------------- t ' Field (Specify Requirements) ------------------- i ------------------ ------- ------------------------- ---------------- r ----- ----------------- --------------------. ---- P - (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 � 4 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: "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 :- - --- ------ ------------ g _ Owner By --- --- --- Title ---- ------ [lf other than owne' OR DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY_______ _--___- BUILDING PERMIT ISSUED - :: : . DATE hh ------------ ------- ---- 1 ,---.---DATE4J ADDITIONAL-COMMENTS .-. ----------------------------------------------------- -- ----------- ----- - - --- r- ---•-------- --------- ---------`------------ -----------=--------------------------------- -- ------------------ -------------F- = ~------- --------------------------------------------------- - -------------------------------------- --------- ----------------------------------------------- ----------- -----------=----------- - Final Inspection by:- ----- ---- ---- ------ -------------------------------------- Py b_ ---------I---- =-- - - ------ -- ---=---- ------- --- ------------Date - --- -- - -------------------------------= SAN JOAQUIN- LOCAL HEALTH DISTRICT •E. H. 9 1-'68 Rev. SM