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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---._.._..-•-•--_--•-••-•----•--•-••--- ------------ - (C-ompletp in Triplicate) Permit No. ..7L--6__3. -•-- This Permit Expires 1 Year From Date Issued Date Issued 't7;telAppl�� A-4 l�c[c°-� v E 4-1J T D Sy— r cf0- -2-1 ' ication 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: JOB ADDRESSON ...` j�,,�- �ENSUS TRACT ... .4/_•._._ _____- Owner's Namee . ....._� -•---...Phone -.... ..--•-----•-- •-•----------- .. - _-- Address .._-...�'. �.. .-O ._ • - •. . -•-•- ._ ---...City ....... ----•----•-•--•-•---•---- Contractor's Name _- -_-_ ........License # z p 3�?�P one Installation will serve: Reside ce Apartment House Commercial❑(Trailer Court 0 � Motel ❑Other Number of living units:__. ...._- Number of bedrooms ......Garbage Grinder ............ Lot Size ________________ Water Supply: Public System and name --------------------------------------------------------- --------------------------------------------------.Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay [I Peat 0 Sandy Loam fl Clay Loam ❑ 1 4 Hardpan ❑ Adobe Fill Material ---------- if yes, type ....................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is-available within 200 feet,) PACKAGE TREATMENT [ ] SEP14-0-a C TANKA Size.-S"X f•a--�_._ ��_ Liquid Depth ___.S'-/�-� ....... 1 Ca aci f p ty ..._-_.__ Typ . _ ,--,,?....__ Material _._._. No. Compartments .._.. _._......_ j111 y. J Distance to nearest: Well P_..............Foundation . .- l�._.._...- Prop. Line ............... r •f - LEACHING LINE No. of Lines --------- -- Length of each line ------ .___ Totai Length __._� + # . - 'D' Box ----IT.-.- Type Filter Material ......5„/3,__.Depth Fiiter Material ------1.1..........................._..._ Distance to nearest: Well -. ............... Foundation _.- ......... Property line .__,_ ---____-_____ S � SEEPAGE PIT j Depth ___a___ Diameter ._-�. ...... Number ----- -=':�------------ Rock Filled Yes i ft No i❑ i Water Table Depth .............. -�..................__---Rock Size Distance to nearest: Well ---------------- .�___...............Foundation ----0'_. ...... Prop. Line ... ------- _ REPAIR/ADDITION(Prey. Sanitation Permit�# ------------------_..................... ... Date ------•----•----_____•__-______1 . Septic Tank (Specify Requirements) ------------------------------------------------ - ---------------•------------------------------------------------...... Disposal Field (Specify Requirements) ----•------------------------»---------------------------------------------------------`---------•--------------__----•--•- .... -- ----- ----- ._._..- . -- .....................••-•-------. --•----- ------ ---------------------------------------••---••-- 1 - - (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 "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 arkmoos Compensation laws of California."Signed .. - -- .. --- - .--- Owner I lBy ---- ......._ .... ... {-:..: ._,.. _ 4-LIC, Q_._._. Title .- -t-Ll/l�.QIP_� _O_ ._....._ _.`.......-•-•-----•-•... t (If other than owner) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...e: DATE ._�_"�_ "7.!Z^................. •••------•-----• •---•------ - BUILDiNGPERMIT ISSUED...--------- -----------------------------------------__--_--•---•----•--------------------------DATE -'----------.._...................... ADDITIONALCOMMENTS-------------------------------------•—-------------__-_--•--•------------••--•-------------•----_-__---.---------------=--------------------- ----- ----------------------------------- Final inspection by: .........- - --------........--••----•-•.................._•------•--- ----.Datel:_ -4-: .. .... - t SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M a