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FOR OFFICE USE: APPI %TION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. Date Issued ../_.... / - -. This Permit Expires 1 Year From Date Issued kpplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein lescribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ._ . J`�- `__�_ _. ___ �s-fit --�� --------- CENSUS TRACT -..-... . .-- -------- Owner's Name l �- �L�-t'�i Lees:-c4, / Phone - Address -J'� %� �tL''.. �a------ d City `" c- - - Contractor's Name _ r��t�� _- - '�-------------.License # 1X1__3. P7-_ Phone ----------- --------------- Installation will serve: Resit enc ❑ Apartment House❑ Commercial [railer Court ,❑ Motel ❑ Other =--------------------- Number of living units:-_ Number of bedrooms ---r__-__Garbage Grinder .._--__ Lot Size ..-- 0--c°it-c�- --------- Water Supply: Public System and name --------------------------------------------------- -------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam [� Clay Loam ❑ 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{f Size_ '.X_�_� __SS-- -_---- - Liquid Depth V.-./-_----.-.-_---- V' Capacity ...d_Qv( -C_ Type Material.�e"�_--_- No. CompartmentslJ - c�__--__ -------- OF;,�- / Distance to nearest: Well --.___ -c---- ------ -------- p. �_______-- 6 ------Foundation ______1_`a-_--_____ Pro Line -.____ ____ LEACHING LINE [/jam No. of Lines ----. ) Length of each line----_---P.__._._.---_ Total Length ------6_'0----_---------- 5 ►Z 'D' Box -`__. Type Filter Material _-___.__�_____�--Depth Filter Material ----/4________________________________._ , i Distance to nearest: Well - _. Q.�--_.--- Foundation --__!__Q_------ - . Prope Line P ty ------------- SEEPAGE PIT [ ] Depth Diameter _______________ Number .. ------------------------ Rock Filled Yes ❑ No ❑ h Water Table Depth - - - ------ --------------------------Rock Size --------- --------------------- Distance to nearest: Well _-_.__.__- - _-------------Foundation --------- -- Prop. Line -------------------- H REPAIR/ADDITION(Prev. Sanitation Permit# ___.-_ __ _ Date ------------------------------I D' Septic Tank (Specify Requirements) __-_ -_ ---------- ---------------_--.------- _--- --_---__..-. m 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 �bj ect to Workman's Compensation laws of California." Signed ------ c - - - --- Owner _ - - _- -. - - _ .-_ Title .e9h.�ucQ- / By . -- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------------------••-------------------------------------------. DATE .1_-_k-,7/-•------------------- BUILDING PERMIT ISSUED --------------DATE .-----_..-.---_-----.___-_-______-__--_-___ ADDITIONAL COMMENTS ----------- --------- .__________________________ ------- _ - - ------ -- --------- - --------------------------------- -------------------------------------------------•----------------------------------------------------------------•-- ---------- ----------------- ----------- - -- ----- - ------------------------------------------------------------------------------------------------------------------•---------------- --------- ' �` - --- ---------- FinalInspection by: ---------------------------------------------------------- ----------------------Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M