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EOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No: 36. 7 ------ -------------- --------------- ---------- '� (Complete in Triplicate) , -------- .- -- 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 Ordinance No. 549 and a 'sting Rules and Regulations: JOB ADDRESS/LOCATION ._ �1_�-��--��------- �1�)2-�--'-1�- --------/2-4 _--CENSUS TRACT -------------------------- Owner's Name _�/, _J/1J-I` __'q 1a------- / ' 1�� -------=------------ Phone. + 1 7` r----- � �i - - Address _ _�� - -� S-- i�i_1yt0!V_------7�` City _ p Contractor's Name J `� ---------------=--------License # y� Phone C' - r Installation will serve: Residence P§Apartment House,F1 Commercial ❑Trailer Court Motel ❑Other -------------------------------=----------- Number of living units:---I------- Number of bedrooms ---Z----Garbar ge Grinder-- Lot Size ------ Number Water Supply. Public System and name ---------------- -------•-------------------------------------- Private E] I y Peat Sand Loam - Clay Loam:❑ _Character of soil to a depth of 3 feet: Sand (�T -Silt❑ clay ❑• ❑ Y ❑— y' Hardpan ❑ Adobe'❑ Fill Material _W�---- If yes,type -_.________________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc, must be placed on reverse side.) seepage pit permitted if, ub� sewer is available within 200 feet,) {� NEW INSTALLATION: (No septic,tank or L - PACKAGE TREATMENT [ ] SEPTIC TANK'[ J Size-3- _ _________ __ _ -- ------ Liquid Depth _ ------- --•- �, �yMa riai__ -- )R_ No. Com �__________ Capacity '_4__�-�--------- Type -- ��`------ --- Compartments p Distance to nearest: Well -------- / _-Foundation -------- Prop. Line ---6->--------- ------ LEACHING LINE [ ] No. of Lines ---------f________.__ Length o each I e------_/pe------------"Total Length ____.�--------------------- e'D' Box J--------- Type Filter Material ___ ----------- --- .Depth Filter Material -------- ------------------------- t - _ Foundation ------------------------ Property Line. ------- -- Distance to nearest: Well _________________ _ � --------•"--- SEEPAGE PIT [ ] Depth ' Diameter ___ Rock Filled Yes No Number _..-- ------------ - ❑ i Water Table Depth ------------- ---------------Rock Size -------------------------------- 1 ---------------Foundation -------------------- Prop. Line -----------•-_---- Distance to nearest: Well __________________: -- " REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------} Septic Tank (Specify Requirements) -------------- Y_.I]- ----- ---- -----------------/-AJ----- Disposal Field (Specify Requirements) �'p �R�=-- rN -= /2 ,r____>p/t7 - -- /'=------�°t', ---- -----= -- �. � - _ LilV_ ------------------------------------- -- ------------- - I (Draw existing and required addition on reverse side} I hereby certify that 1 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 sof the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Work n's Compensation laws of California." ' Signed ------- j Owner . ' ------------------- Title ---------------------------------- -------------- ---------------------- By ---- (if -- ----------------- B (If other than owner) FOR DEPARTMENT USE ONLY ---------------------------- /-----. DATE �r - '7f - ------------- APPLICATION ACCEPTED BY __�i_�-�___'------------------ ------ - -- ' BUILDING PERMIT ISSUED ---- ----------------- --- ------------ -!----------DATE ----------- -=--------- ------------- ADDITIONAL COMMENTS _ =----------------------------:-------------------------- -------------------------------------- -------- -------------------------- --------------------- -------------------- --- - -------------------------------------------- ----------------------- ----------------- ------------------- ------ --------- - --- - -- - ----------- ----------------- ----------------------------------�_ c ------------ ----- - f Final Inspection ------------------Date ------- - -- �----- �" SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M