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OR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------- -----------------=-------- n — =_ _ . (Complete in Triplicate) Permit No. Iz' . ------7 ----------- This Permit Expires 1 Year From Date Issued Date Issued___,��.Z_'{: r' 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: JOB ADDRESS/LOCATION If _ .--_ --.- --- -I*- R-- ----- -- ------------------------CENSUS TRACT -------------------------- Owner's Name ._1 .� _ _ l l _ VAY--WP/M.1 , �---Phone-477-- -� -f- j Address ----------------2__ --f-D----- - �-i_o- ---A--VF------. City - , `� -47 ----------J--,4-z------------- Contractor's Name --P&&�--P.I's -------OV C----------------------- ---------License # �O( f 1 Phone &_,?_ -A---- 1 Installation will serve: ,, Residence ❑Apartment House❑ Commercial :❑Trailer Court ❑ ! Motel ❑Other Number of living units:------------ Number of bedrooms ------------Garbage Grinder ------------ Lot Size,, . . -- -a_______________ l Water Supply: Public System and name -----------------------------------------------------------------------------.------ --------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ / Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam .E] 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) t , I PACKAGE TREATMENT [ ] SEPTIC TANK Size_��.__ ___,__ --------------------- Liquid Depth � ________________ Capacity IZ100------- Type JrOMP,EdW'"Material ICAffl~AVIC"No. Compartments -_------__-_ Distance to nearest: Well ____ "_____________Foundation ._ ___ "_-___ Prop. Line .. LEACHING LINE No. of Linesy (t)_ ____________ Length of each lyine__.. 'rE ---------.------- Total Length SU_.________.__.__.. 'D' Box .-- ------ Type Filter Material Depth Filter Material /1_11--------- --------------------- I Distance to nearest: Well _�_00__�---.___ Foundation �_O._._............. Property Line_ .�___."'�____,______ r tt )- i Rock Filled Yes No Number , ____- , SEEPAGE PIT [ ) Depth -9.5____-- _-- Diame�er _______________ 1 �-�1 � 1❑ Water Table Depth --.5v-------- -------Rock Size -1_ ------------------------ Distance -- ----��----- ► Distance to nearest: Well _ __________________________Foundation _.:_" '__ Prop. Eine ______________-_-____. REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------I SepticTank (Specify Requirements) -------------------------------------------------------------- -------------------------- ---:-------------------------------------------••- Disposal Field (Specify Requirements) ------------------------------------------------------ - ------------------------------------ ------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- (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: a "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 b e s bject to Workm n's C Compensation laws of California." p� p Signed ----- ----TA-- . -.._ i .-I Z 11 --------- Owner Y B ° Title ` -- -- --- ----------------------------------------------- (If other than owner) ~ DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ ------------------------------------------------------------� DATE7 ----------------- f BUILDING PERMIT ISSUED ------- = 7 ------------------------------------------------------DATE ---- ---- --------------------------------- ADDITIONAL COMME S __.___ ___ _. ____ - 64 r-------- - '�j -A-------------------------------------------- ---------------------------------- ---------- ---------------- -- -------- ------ -- -- -------- -------- ---- -- ----------------------------=---------------------------------------------------------------------------------------------------------- ----- ---- ----- ------ - ------ - ----- - - ------------------------------------------------------------------- ----------- - ------------- ----- ----------------- Final Inspection bY: -------------------------------------- - -Date -- y --,? ------- N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Re . SM