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FOR OFFICE USE: APPLICATION'FOR-SANITATION PERMIT ' 'es \ Permit No: _.73 -- ---7,- iComplete in Triplicate) - J --------=-- ---------------- --------------- -- This Permit Expires 1 Year From Date Issued Date Issued q Ordinance No. 549 and existing Rules and Regulations: �3 Application is hereby made to the San Joaquin Local iVealth District fora permit to construct and install the work herein described. This ap c tion e i co li + h my O I � � Y B ADDRESS LO�ATION .---.- - -�- --° ---E�-- -GIS -S-:----- 'gO__�-�-1 -_.. � / ENSUS TRACT ----------------------- -- JO / � _ 1 Owner's Name ------------- Phone ;; -------------- ? , Address ..Je4g`4- -- - m Cit C'/�/7 Y _ - _ Contractor's Name /4-J(�/� I'' -----------------------------License #a �.J�_-s --- Phone�o�__--,4 --,-- Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other _ ----------------- Number of living units:-.4� Number of bedrooms ___ _--_Garbage Grinder K1OF_ Lot Size .3 \ IPrivate El Water Supply: Public System and name ---------------------- -- ------------------------------------------ Character of soil to a depth of 3 feet: Sand'❑ Silt F] Clay El Peat❑ Sandy Loam -E] Clay Loam El ii Q I Hardpan ❑ ,Adobe Fill Material ------------ If yes,type ------------------------- 11 ti (Plot_ plan, showing size ofelot, location�of system'in relations to wells, buildings ^etc. must be placed on-reverse side.] , NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is cyail5blewithin 200 feet,) i;� l PACKAGE TREATMENT { I SEPTIC TANK,W Size_ �:f' � - Liquid Depth -------®�j3-• CapaciW?:-1 41V--- Type �___ Material_ .c-- No. Compartments ,e--=-�.-�-... t Distance to nearest: Well ------------------------------------Foundation __/149------------ Prop. Line ----�.________-_- 01 LEACHING LINE No. of Lines ----- _______ Length of each line.`G ------------- Total Length _�.Q�---------,--- 'D' Box Type Filter Material .- pt�Filter MateriaProperty s p Line -_- -�-� YP f Distance to nearest. Well ___,__--_,______________ Foundation �f -- 9 / ____ Number ----------------------- Rock Filled Yes No o SEEPAGE PIT ]' Depths ___ Diameter ,,?L�__- r _ �i f� - � Rock Size ___ ____ . - - Water Table Depth ______.�,� ---------- -�'�-�.� � � -------------- Distant 1 to nearest: Well --- _--- ��----------------•-Foundation ---- ---- Prop Line __ �.------__-- a - ---q ---------- REPAIR/ADDITION(Prev. Sanitation -------- ----------------------------------- Date ------------------ Septic Tank (Speci Y aquirem 1- •--- ..---- ----------------------=��i --- Disposal Field '{Specify Requirements) ----------------------------- - =�------------------j--- ----------------------- -------------------- ` jL ____________________________________________________ _____________________________________________________________________________________________________________i__--_________._______ F ` 'I (Draw existing and required addition on reverse side) ! hereby certify that I have prepared this application and that the work wil!be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Reguiations of the Sari Joaquin Local Health District. Home owner or 16n_ 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 Compensationlaws of Callfornia. i '.Signed ther than -- -------------------------- Owner Ji ------------------------------ - -------Y ---- owner} r i"• 11 FOR DEPA-RTMENT USE ONLY F APPLICATION ACCEPTED BY ------------- -- ---- - ------------------- ----------------------------------------------- DATE' BUILDING PERMIT ISSUED ----------------- - ------DATE ---------------------------- i3 ADDITIONAL COMMENTS ----------- ---- - -------- .' ---- ------------------------------------------ ----------•- --------- ------ -------- ----------- ------ -- + -------- -------------- -------- ., ---------------------------------------------------------------------------- -------- ------------ -------- - -------- ----- -- -------------------------------------------- --- --- - - ------- ---- - - - Final Inspection b ' --------- Date 3 .i i - �tx SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -