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FOR OFFICE USE: APPLICATION FOR SANITATION PEWIT �+p /•c�—� r _ Permit No. (Complete in Triplicate) Date Issued _ 9 This Permit Expi er s 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Dicstrict for a permit to construct and install the work herein described. This application is made-in compliance with County Ordinance No. 49 and existing Rules and Regulations: c ', �, ENSUS TRACT -------------- ----------- JOB ADDRESS/LOCAT N - 4a �. ----------------- ---- Owner s Name -------- 1'•�'I;--- ,------- ---- k ---------. City Address -- ----------------------- 1 "Phone `ti.f •�P _ - �_ License # --------- ------------ Contractor'sh ne Name __.---___ ---*---S `------- - --- Installation will serve: jj ResidenceApartment House Com einem--- Apartment Court ,❑ 1 Motel ❑Other .---- t ---------------------------------- Garbo ------------ 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 !] 'Ciay E]— Peat ❑ -"Sandy Loam ,❑ Clay Loam Hardpan ❑ Adobe Fill Material ------------ If yes,type-------------------------- buildings, .etc. must be placed on reverse side.) (Plot plan, showing size.ef lot, location of system in relation to wells1., NEW INSTALLATION: e►(No septic tank or see age pit permitted if public sewer is available within 200 feet,) I I . PACKAGE TREATMENT [ SEPTIC TANK'[ ' ""' Size------=-=--- :�-±h_-=-J'= " - Liquid Depth ---- -------------.- -.� y f� •► -- Material- 6f"`" ^' — Compartments :. �1 Capacity T P� Q �. oundation ------ ~ Prop. Line __-5-------- ---••--- Distance to,nearest: Well ---- &--/ - --- o Tota! Lith_: ----------•-- LEACHING LINE [ ] No. of-Cines Length of each line__.___--` 1 l _. » 4 _el ---De thrFilter--Material + _✓ Type-F{ter,Materiel,__(�?r''�--- P . / --property � I f ; � - Distance to nearest:Well _:_t'_ -_-k_- -- FouE.ndation�_.__l .---Property Line. ------- Distance ----�- =-- SEEPAGE PIT [ ] /De�,t S-.------ Diameter 33.1-'-�Number _---_.___-Y___` Rock Filled Yes No ..----------- -------- L �----Rock Size W 'ter Table Depth _____._.--_ -- � P t Foundation ----1.�-------- Prop. Line .... Distance to nearest: Well ---___:__�4�------ REPAIR/ADDITION(Prev. Sanitation Permit ------------ -- --- ------ ate _ ____. ---- -------- ) -------- 1) -ge-41- k 4_ V I' Septic Tank (Specify Requirements) ---- -- - - , _ - de I Disposa Fi (Specify Requirements) --------------- A ---------- -- --------- ---------- 'G, `_ --- - --- -- ------ - - - --- --- lr _YK- , �.�. •# --- - -� --- ---- - ------------- --------------------- - ------- --------- - - ---- ---- ----- - _ J / v -S aw existing and required addition on revers side) I herebl 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. Horne owner or licen- sed agents signature certifies the following: A IE "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." 1 Owner Signe � __ ------- -2�� ---- - ----------------------- -------- BY -- --------- _w _.,._ _ Title --- P (If oth an ownesl� _. - f h ► FO, D ARTMEiVT.IISE ONLY ..,. , ��r k , \ APPLIC�AT ION ACCEPTED BY DATE ------------------------- BUILDING PERMIT ISSUED -- --__---- DATE ------------------------- ---------- - - -- - p ADDITIONAL. COMMENTS �1��` ------ -- -— ---- -- ----------- ----------------------------- i ---------------------- -------- --- ----------------- --------- --------- --------------------- --- __ c Ddte --- ,.� - ----------------------------------------------------------------- -- ---------- - Final Inspection by: __ _ ___ - - - ---��- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M. `-