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. ., F.OR OFFICE USE: APPLICATION FOR SANITATION PERMIT r - -------------------- -------------- (Complete in Triplicate) Permit No. _71-3 92 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 existing Rules and Regulations: { r JOB ADDRESS/LO TION -_�-------Q_-71----�---- _-____ ___________Z�e-- -.-------- G.------CENSUS TRACT --- `; _>_-- Owner's Name � ----------- .-----.---- F -------Phone ------------------------------------ Address ..`�.�.11---7! r ------------------------------------------------------------- - ---- ---- ------ ------ ----------------------- city L ^ © gam ---- I---I- -----------------------y---- f-------------------'- 02--"" .A-__T_7 Phone --.4"-""---"-------------•-Y Contractor's Name � License # �k Installation will serve: Residence X Apartment House ❑ Commercial ❑Trailer Court ;❑ Motel FJ Other ----------------- f ----- I -------------------- - f Number of living units:------I_-._ Number of bedrooms` _____Garbage Grinder --- -"---- Lot Size --- ------------------ ___________ Water Supply: Public System and name ---------------------_---------------------------------------------------------------------- -----------------Private, ' Character of soil to a depth of 3 feet: Sand'E] Silt❑ Clay ❑ Peat❑ Sandy Loam;K Clay Loam ❑ Hardpan ❑ Adobe;❑ Fill Material X02-- if yes,type ___________________________ - r (Plot plan, showing size of lot, location of system in relation to well's, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if ubiic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 5 q _--__._{___ Liquid Depth ----q_1 :_,_____ .Q Capacity l oo Type _r ~t _ Material__ --�- No.. Compartments ------ --------- � Distance to nearest: Well r?Q-----------------------Foundation ----L_d---------- Prop. Line LEACHING LINE X No. of Linyes ______________ Length of each Ylr�ne.__._. --__70 Total Length (,__ .r_._____ L. 'D' Box -_t_1--_--- Type Filter Material�J "" Depth- Filter Material _ _____I_ 10 f x( Distance to nearest: Well ._- " _""Founelatran ""`=. _d_"`:___._ Property Line --- -------- Distance e SEEPAGE PIT [ ] Depth ____ _______ _ _ ___ Diameter ___-__________ Number ---------------------------- Rock Filled Yes [] No 0 t - r" Water Table Depth -----------=------------------------------�- Rock Size'`------------------------.------- Distance to nearest: Well ----------------------------------------Foundation --_.____._ ------ Prop. Line ---------------------- REPAIR/ADDITION _________________ _REPAIItfADDITION(Prev. Sanitation Permit# --------_--------___.--------___-_s-_ -_ -2 Date ---------------------------------- Septic ____________________________--___Septic Tank (Specify Requirements) Disposal'Field (Specify Requirements)�R :_ R�J��11--_---��----------- --------( - t��--L—_----------- i -------------------1/._ -------C.0U_�5F : 5A?q ---------kD--------------�1l_ ' ----------------------- ------------------- --------- - -------------- ----- - --- ----- -- --- ---------------------------- (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 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 By -----1--------- --- - -------------------------------•. Title -': --- ------------------------------------- ------------------- (if other than owner)` - s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- f ---------------------------------- ------------------------------ --------- DATE ------- BUILDING -----BUILDING PERMIT ISSUED -- -------------------- - -------------------- ------------------ -------DATE ------------------------------------------- 1 ----------------------------- - ADDITIONALCOMMENTS ----- ----------------------------------------------`-------------------------------------------------------------•------------------ - - ----------- -- - - - ----- --- ---- ----------- ---------------- J I --------- - - -- --- -- -- -------------------------------------- Fina x-------------------------Date ------ ------- SAN JOAQUIN LOCAL HEALTH-DISTRICT z E. H. 9 1-'68 Rev. 5M *. s,i -