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FC ? OFFICE USE: \PPLICATION FOR SANITATION PEP! T --------- -------- - -------- � 1./ Permit No. ..7 3� T (Complete in Triplicate) . 77 - This Permit Expires 1 Year From Date Issued Date Issued .................... Application is hereby made to the San Joaquin Local Health District for a permit to constrrict d�nstc♦f[1il�Rvdjk herein described. This application is qdg i9 mpliia�nce with Couuntyy Ordinance No. 549 and a sti s ul ions: JOB ADDRESS/LOCATTIIO �/N t=t <l�-sJ�3a�f(o--FCz -7e - - - ...._... CENSUS TRACT S y - Owner's Name -._LYGr........ ' ��-- y� ... - Phone --- Address -• -- - - -- � % I / Contractor's Name r t2IT.r -- ___..__..__._.___-___--License # ��. d'� -- Phone Installation will serve: Residence ❑Apartment House C] Commercial XTrailer 6vw o-❑ Motel ❑Other --------- ------- ......................- Number of living units:._.4... Number of bedrooms ...Z---Garbage Grinder X10---- Lot Size ...c........... Water Supply: Public System and name ------ -------------- ---------••------------ -------- -----------•---------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 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 sir',,, NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK;K Size_fjf,X -- -------- Liquid Depth .._................ o Capacity/,?eel-....__ Type A�___ Materiale*oo d'+__.___ No. Compartments . ............... is Jr . 6 Distance to nearest:.Well .-__. r�� .--..._.._..._.-__:1Foundation �L!�..___.... Prop. Line ....L.-�_.�..'.._..--- � LEACHING LINE No. of Linei_. Cergth of each line-_i%eey__..___-- Total Length AM................ 'D' Box /kk_ Type Filter Material D,;fl) Filter Material .43.w---------....................... Distance ito niatest: Well _-4161&--------- Foundation > &-__._..___.. Property Line feA........... v SEEPAGE PIT Kj Deptht* u---�_.:,.. Diameter � ----- ._ Number ._�r__--_.._...__ Rock Filled Yes No Water Table Depth _.._---, Q-_`----------------------------Rock Size` p Tir ------.--- Distance to neares}:,Well _,_. . .............Foundation ..Tt�.--_..__ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit d� ...._.-._---L------ ---------------------- Date _,5,,.,.----- ---- ---------I Septic Tank (Specify Requirements) !KDate - -------------------- - ---- --------•-----•----- ------- Disposal Field (Specify Requirements) ...... . ............ ----------------------------------- --------------------------------------------------------------------- -------------------------------------------- ----- ------------------------ - - ---------- .........-------- ........... \ - --------- - ------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) 1 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 lawi of California." Signed -----------------------` - - --o --- - -- Owner y . By ----------------- - ------------ ------ Title �y/s"'ter - _ n -- --- -------------------- ----- ��%�r- -- (If A an ower) t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - -- - - ---- - - ------- --- ----- -- -----...---------------------.. -._.... DATE /'-3 �� ------------ BUILDINGPERMIT ISSUED ------------- --------------------- --------------------- ----------------------------- ---------DATE ADDITIONALCOMMENTS ----------------------------------------------..._..-------------__---------- ------------------------------ ----- ...-------------I--------------------------- -- ------ -------- --------- - ------------------------- ------------------------- ------------------------------------ -------------- - - - - - - - ------ Final Inspection by: .. _ - - .__ ' -. .. _. _ _ _. __ .Date% =-J SAN.JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M