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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------------------------------------------------- Permit No.. (Complete in Triplicate)01 l ' a ---... " Date Issued This Permit Expires 1 Year From Date Issued 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 OrdinancJ No. 549 an4 exist- Rules and Regulations. i JOB ADDRESS/LOC ON �%�2�, Sa,_ -��1�11:/ ----- -41-� � �-� CENSUS TRACT ___._____�.____ /- ----------Phone Owner's Name -� 4 -/ SC J - Address-. � ?, , ----------------------------------------- ----rity �_` T --------------------------- --------License # 17iq -9--- PhoneContractor's Name Installation will serve: Residence�KApartment House❑ Commercial :❑Traiier Court i❑ 6 �-��) Motel ❑ Other -------------------------------------------- Number of living units:_________ Number of bedrooms -9------- Grinder Lot SizeD ------ Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt C] Clay_❑,- Peat-E] .—Sandy Loam Clay Loam-[] � [ HardpanZq---Adobe ❑ Fill Material Nib---- 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: IN se c tank or seepage pit permitted if public sewer is available within 200 feet,} j PACKAGE TREATMENT [ [ SEPTIC TANK [ ], 'j� Size------ x_j0_X_1o__ Liquid Depth —_____-•__ Capacity 7X00-_---_ Ty Materiai4�_�-_______ No. Compartments __ _______. ;�",/ r 1;stance to nearest: Well __fes________________ _ _____Foundation __ _ Prop. Line __ _ ____.______ LEACHING LINE [ No.,,of Lines - 1----- Jr--� �� �- Length of each line__._ _7 - Total Length --- ..� D' Box ��___ Type Filter Material• L Depth Filter Material _______If----------------------------- q 3 f •' _ , ( Distance to nearest: Well __� __ ________ Foundation ._4�___---------- Property Line _.1'�___.,:._:___- > SEEPAGE PIT [ � Depth fi�_-r--------- Diameter V yl---- Number .-------- __________ Rock Filled Yes ��lo 0 Water Table Depth ---- r---------- ---------------•---Rock Size f�Z-- z�. I .Foundation ____ ---- Prop. Line �_________.___.: ; # 1 REPAIR/ADDITION(Prey. Sanitation Permit# _________-----------------------------------_ Date ______. -------------------------- Septic Tank (Specify Requirement s) --------------(/y 7 ate_ ------------------ ------------------------ Disposal Field (Specify Requirements) -------------------------------------------- r r 5 -. i _ ___ _ __ a ------------------------ ------------- ______________ _ _ _ __ ______________ _______________________ ____ _ (Draw existing and required addition an reverse side] I hereby certify that I have prepared this application and that the work will be"done in accordoncyw•wiN San Joaquin County Ordinances, State Laws, andRulesNan Regulations f the San Joaquin-Loi al.diealtli;.D'rstrict. Home owner or licen- sed agents signature certifies the,fell _wing: �� "1 certify that in the performpnc of the work"for whic}i Phis permit is issued, I shall notot mpioy'anyrersor�in such manner as to beco e s jest to Workma�[s Compensation laws of,California." ' Signed ) ----- _ . _ _ . _ ____ Owner IBy -- - ,f�j= ' `' r ,` T ;— ----------- i, (If other than own ") I FOR-:DEPARTMENT USE ONLY BUILDING PERMIT ISSUED�Y - [PATE -----9= - � iY= ------------------ APPLICATION ACCEPTED ._r_ _ l' ------ t DATE t ------------ ADDITIONAL COMMENTS-------- ---"'�t------------------------------ -1�----�----P�----------�--------d-'-�-1-------_- ---------------- - --------`--- `----- -----------------------------------} i-----�3--------- 23 --------- k ---------------------------------- - --- - -- ------ ------ - ------ ---------- Final i —� r Final Inspection b --------y-----v -- - ------- ------- Date = . - SAN JOAQUIN LOCAL HEALTH DISTRICT `F °� ESI-!.9 l-'68 Rev.'5M