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FOR OFFICE USE: y i ICATION FOR SANITATION PERMIT --------- Permit No. 70 `� -&77 (Complete in Triplicate) = ---- ---------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued a 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 Regulations: I ----- -1--------Y,*1 -------/�`I -------------- ----- ---------------CENSUS TRACT ------------------ JOBADDRESS/LOCATION �� -------- Owner's Name -. /j�� /�,/Jr1� - ------------------Phone._7� r9 --••---- Address ----- ��/�j A �x6�' //�-s-��------------------------------ City Contractor's Name.../'</?'-'- /¢.-+ !Si - `_, 5 L��✓�•-_ << --- Phone - 9--- 1.-_-- License # ��- Installation will serve: Residence 2?1(partment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other ------------------------- jj Number of living-units:---1___=Number of bJeddra s _X-----Garbage Grinder ------------ Lot Size ------_______-__________--..-_______.___ Wafter Supply: Public System and name __�i-��_`�_kIA-C-Cle---------------------•------------------------------------------------Private ❑ ' Character of soil to a depth of 3 feet:. Sand'❑ Silt L5J Clay .❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ i Hardpan ❑ Ado K Fill Material ------------ If yes,type.____________________________ (Plot. plan, showing size of lot, location of sy'litem in lation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit p itted if pvblic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTICTANK'[ ] Size------------ ______-_---____________ __ Liquid Depth --------------------------ti � _----- Material- ---------- -------- No. Compartments ---------------..:: Capacity •-•----------i---- Pe ------- - -- �- p .� 1 y Distance to nearest: II Foundation ---------------------- Prop. Line --------------------- " LEACHING LiNE [ ] No, of Lines --------- __.__ Le of each line____________________________ Total Length .-_______-,--.-__________-- . ! 'D' Box - Type fil' -r terial ---------------------Depth Filter Material -------------------- ---------••------------ � t i I Distance to\nearest:, ell, _ ._F__________________ Fouridation - _—__________ Property Line SEEPAGE PIT: [ ] Depth -- ------- .-Z---- iam ; ________________ Number --------------- --------- Rock Filled Yes ❑ No 4 -----WaterTable=De th ----- - ---- _Rock Size --_---=------------------- t Distance to nearest. Well _'_.__1----------------------------....Foundation ------------------ Prop. Line ----------_-.-•-.•-- REPAIR/ADDITION(Prev. Sanitation Permit S# __ _____ ----------------------------------- Date ______________.________________-�-} Septic Tank (Specify Requirements) _4700----------- Disposal Field (Specify Requirements) ________----------` ---------- ------------------------------- ------ ----------------------------------------------------------------------------------------- --------------------------------------------------------- I I --F- - - ---------------------------------------- -------------- ' {Draw existing apd,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 Y 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 to Workman's Compensation laws of California." Signed -------------- - Owner ----------------- BYTitle r ------------ - ---------------------- : {If other than owner) � [tTMENT USE ONLY APPLICATION ACCEPTED BY ------ _ . _ _ �� - ------------- - - --- --- ------------- ---- -------- ------------. DATE --- --".'-- BUILDING PERMIT ISSUED ---------- - --- -- --- - ---------- - ---- DATE - - -------------------------------------- ADDITIONAL COMMENTS --------- - - ---- ---------- --------- - ----------------------------------- --------------------------------------------------------- -------------- ------------ -,----------------------------------��---------------------------- _-_:----------------------------------------------------------------------- •------ - .y N.._ _ _ . _. _ .. . - Final lns ection b - ( .. -SAN_JOAQUIN_LOCAL-HEALTH_.D.ISTRI.CT_.—,,,.,. E. H. 9 1-'68 Rev. 5M