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ZI so 2 ? a7 f3 cGur FOR OFFICE USE: •` ,� APPLICATION FOR SANITATION PERMIT 3 --------------------------- ----- Permit No. _' (Complete in Triplicate) ---------- Date Issued - -_r`,7�_. This Permit Expires i YE* r.F�m bate Issued f Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein r 1?-7k described. T is plication is made in c;� plias a wit o my Ordinance Na. 549 and existing Rules and Regulations: i J1 AD ESS LOCATI�N�----_------------------ l-t------ cr -r-----1 't' .........5_� 4r.4-k..........CENSUS TRACT Owner's Name --------------- --------- ��s.+ G -.--------------------------------------- /---------------- ----- - --------------------Phone ----9Yk pi,2-at . Address --------------------�..`7�. --------&------ 5/�'� ``'� J-ter_. . ._. City ---------------------------------------------------- --- Contractor's Name ------------� '�. --- u —------------------------ ---------.License # ��.- b Phone ----------------------1- • ••- Installation will serve: Residence (`Apartment House-[] Commercial ❑Trailer Court 0 Motel ❑Other ------------ ------------------------------- - GG r Number of living units:.../------- Number of bedrooms ..._;:�.-.-.Garbage Grinder Lot Size ---------- ------- Water Supply: Public System and name ----------------------------------------------------- --------------------•--I----------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt:❑ Clay ❑ Peat❑ Sandy Loam .[] Clay Loam;❑ k Hardpan ❑ Adobe 9 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.) _y NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, I ' a ,`PACKAGE TREATMENT [ ] SEPTIC TANK'. Size......... ------------------- Liquid .Depth Ca acitY --19 Z------- Type Material _�L- _� .__ No. Compartments •--•-•--•------- Distance v a to nearest: Well -._.....�'...................Foundation ---_/_0......._... Prop. Line �_1._... _.._.._._._ LEACHING LINE: - No, of Lines_ 2_�_-__-P_ Length�of each line. _ ii�.r._.___.-.—._ Total Length 1 -...-...s__..-.----- ---- a ` 'D' Box ..- Type..Filter Material ----.,14cri4—Depth Filter Material --------------------------------- i Distance to nearest: Well J_V............ Foundation ---/_0.'_------------- Property Line -5___ . .._5-_._.._. !i SEEPAGE PIT A Depth L Ar r--. Number ___.7�_------ ----. Rock Filled Yes No -�----------- Diameter � - --• --- /--- � >D Water :Table Depth ------------f ------------------------------Rock Size ----Xil:=_ ---------------- Distance -- ------ i # Distance to nearest: Well -...._�4___.�._....-_-.._-...,.:_.Foundation ...l---6_--------- Prop. Line -.r._._._..._._ REPAIR/ADDITION(Prev, Sanitation Permit* -------------------------------------------- Date ---------------------___..-----) Septic Tank (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: "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 a'Wor an's gpon pen satian laws of California." ----------- Signed - -��--elf--�-'------.; --- --------------------------------------- Owner BY :---------------------------------------------------------------------------- --------- Title ..----------------- ', .� ,:.(If other than oner) ------------- ---------------------------------- w —� FOR DEPA TMENT USE ONLY 7 APPLICATION-ACCEPTED BY -U, - ------------• DATE -^ -�-.�:7--------------- ------------------------------ -- ------- - BUILDING PERMIT ISSUED --------------- ------------------------------------------------------ ---------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------ ------- ---------- --------------------------------------------------- ------------------- ----- ----- - --------------------------- --------• -- ----- ------ -- - ----P5M ? -----------------------------------------------------------------------_------ e ----------------------------------------------------------- - -- --- ----- Final Inspection by: Date ...................` 3 N JOAQUIN LOCAL HEALTH DISTRICT E. H 9 1-'68 R