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FDR OFFfCE USE: f. APPLICATION FOR SANITATION PERMIT W L r - ------------------ --' (Complete in Triplicate) Permit No. - ------=-------------------------------------------- -- - 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 construct and install the work herein described. This application;is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCATION -------- - ey--------------------------------.---------------CENSUS TRACT ---------------------_--•- Owner's Name --------•--------------------------------- --------------"--•-------------------Phoned463_4ogo------------ �11 ----------------- ---------------- Address -------Salle-------- ----------------------------- ----------------------------------- city -----•----tkPl,----------- Contractor's Name ...Bla.ckard'$._____- -,----------------------------------=--------License # --2b-895-------- Phorie 4.63-70- -8--------- Installation will serve: t"' Jtesidence:0 Apartment House-❑ Commercial :❑Trailer Court ❑ } Motel ❑Other -------------------------------------------- Number of living units:--.-1------ Number Lot- L..o_t,S_i.z._e.._6�"Xi-28r-4----------------------- Gar?arner�. Y Water Supply: Public System and name ---------City----------------------------------------------------------------------------- -------------Private ❑ . Character of soil to a depth of 3 feet: ! Sand'D Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan EJ Adobe ,® Fill Material -----"- If yes,type ----------------------- --- (Plot plan, showing size#of lot, location of system in reldfion to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permittedLI If public sewer is available within 200,feet,) t, , z PACKAGE TREATMENT [ ] t.. SEPTIC TANK'[ ) Size_-_-----_--------------------------------------- Liquid D'epth -------------------------- 1S Capacity ------ -- Type -------------------- Material------------ ---- --- No. Compartments ------ ----- Distance to nearest: Well --------------------------------- ---- p• ---Foundation'__._.___ _-- ""-._ Pro Line ---------------------- s LEACHING LINE [ No: of Lines .J-__-_______________ Length of each line--- 40-1—.__;.__.----- Total Length ---40-'-.----------------- � r . ` 'D' -Box _-I.- _.—Type-Filter-Material-=_2'"_-_.______._--Depth Filte ,Material,.---------1V!--------------- 7 ' � FoundationIN 1 s . Property Line ____-__ ...... rrl�Distance to nearest: Well _____}�pg__ _._.____.._._ SEEPAGE PIT [� Depth _'_.____.' _ 'i'e- 33"x___Number•=_._._,"'__.l-------------- Rock Filled Yes No Dlarneter __-- _ - s Water Table Depth ----------90-1--------------------- � .._..Rock Size ------2-'1----------- Distance to nearest: Well ------------- -----------------Foundation --59.0-------.._-_P-rQp.._Line ........10 __-__-- REPAIR/ADDITION(Prev. Sanitation Permit=# -_-___------- "---______._yT_ Date -________________________________} 15eptic Tank (Specify Requirements) ---------- -------`- ---------------------------------------------- ------------------------- ----------------------------------------------- Disposal Field (Specify Requirements) ---- IrY�e �c, $3 ---25°X331t----------------------------------------------------- ---------------- i - -----------------------------------------------------------------------------------------------------------"___----------_______-____"_._------------__--------------___-------._--------------------- (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 shalt not employ any person in such manner as'to'become subject to Workman's Compensation laws of California." Signed Owner _--------- ---- -------- - :-:- (;"& - _ e B .._ ... . (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------- ------------------- -------------------- DATE 'a�' �-^ - - ------------------- BUILDINGPERMIT ISSUED ---- ---------------------------- --------• - - ------------------ -------DATE --------- ---------------------------- ADDITIONALCOMMENTS ------------------------------------------------------------------------------------------------------------------------------------------ ------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ..��11��,��.�� - Final Inspection by: ------- —x7141 1----------------------------------------------- -------------------- ----- ---------------- ------------------------------ ate ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT c E. H. 9 1-'68 Rev. 5M