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F0OFFICE USE: VIRLICATION FOR SANITATION PEr''IT ��yy y �`- Permit No.67- S- -/-- (Complete in Triplicate) ---------- _? moi. G -ail-G Date Issued ..................� �` ^, d 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: Owner 's RESS LO fyTl �J .77 CENSUS TRACT / N / D - ! Address - I 1 e "' jl - .... City -Ll'`' /� /f1 ' -- - -'--...License # rv.¢L�X�Phone Contractor's Name .------- _. _.-- -- -------- .... �------- ----- Installation will serve: Residence ❑Apartment House❑ Commercial.[}Tratfer Court i❑ Motel ❑Other --------- Number of living units:._0�_.._ Number of bedrooms .Garbage Grinder .. Garbage Lot Size k�rf-11-. ..e�ZG•Ll� (� Water Supply: Public System and name -------__-----------------------........ ...........-------• ------------------Private J� O Character of soil to a depth of 3 feet: Sand 0 Silt C] Clay ❑ Peat E] Sandy Loam C] Clay Loam ❑ � Hardpan ❑ Adobe V 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.) NEW INSTALLATION: (No septic talk or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK{�} o /$��'ze........ �� -- --__-__ .. Liquid Depth -.--.---- G Capacity Type �idjlNaterial- M-car .-kNo. Compartments .....�----.---- Distance To nearest: Well _..--�_--... . .........Foundation .�1Q..'------- Prop. Line ___o�-�_-.-_. � j LEACHING LINE (}j No. of Lines ----_f$�_---_ ..-_ Length of ach line-.-_ ®._ --_-.---__ Total Length __��. ........._ �t 'D' Box . -0_ Type Filter Material ._4,1.....Depth Filter Material .......l��...I................... Distant To nearest: Well ._.....�_..... Foundation - 1-/Q.. __ 5 ..... Property Line .. .-./_......--. SEEPAGE PIT [ Depth -_ __- Diameter 2 ..... Number --_-./_____________�.. Rock Filled Yes e--'To I❑ Water Table Depth ------- --cS------------------------------Rock Size --------12...__. ?___. Distance to nearest: Well _-__/49a._--....................Foundation _- ......... Prop. Line .. ............. REPAIR/ADDITION(Prev. Sanitation Permit# -------.._-_____.___-.__-__-_-_--_-- Date --------------------------------_) Septic Tank (Specify Requirements) -----------'.-.._----------'----------------...... ----------------------------------------_--.-------- .......—................. Disposal Field (Specify Requirements) (Draw existing and required addition on reverse side) I hereby certify that I 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 ---------- ------------------------------------ ---- ------- =`----- Title ---- .h iL...----------------....._...----- (If other than owner FOR DEPARTMENT USE ONLY cc�� APPLICATION ACCEPTED BY 7 - -------------- ------- ---- DATE --- ---� -- •-" f" BUILDING PERMIT ISSUED -------- --................... ...................'-.............. - DATE ADDITIONAL COMMENTS ------------------------- -- - ' ' '- ...... ----------------------------'------ ---' -------------------' -------- - -------'_"--------------------------- --------------------'------------- -------------- -------------- -'---------------- ---- �} - ------- -------- ---- - - Final inspection by: 7 - 1_14 y-(/� -- - - --------Dote . --- ^1 - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M - ------ — ---------- - -- ---- -- — -- - - .