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OFFICE USE: APPLICATION POR ,SANITATION PERMIT Date Issued(Complete in Triplicate) 4 ._6_k Permit No: -------------------- -------------- ...--_.............. ------------------ ..-..._..-.---- This Permit Expires 1 Year From Date Issued .4--'.C.__o 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 ell, - CENSUS TRACT -27.-,_._ .. Owner's Name ND_Y_ - _°AA _ //� � --------��--�-.d--�--�-�-�----- - ----------------------•------------ ------Phone Address (ta c e�.!'1. .�_.5-r�----------------------------------------- Contractor's Na -�-------------------------- -----License # ------.-------------- Phone =------ - -------------------- Installation will serve: Residence 0 Apartment House❑ Commercial ❑Trailei Court ;❑ Motel ❑Other / Number of living units:--/------- Number of bedrooms _2__ ---- -_ Garbage Grinder Lot Size ---- z_��. -- K�� •----- Water Supply: Public System and name ---- Private ❑ ----------------------------------------------------- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam X 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------------------ ------------- Liquid Depth -----------------•-------- Capacity -------------------- Type ------ Material---------------------- No. Compartments w Distance to nearest: Well ____________________________ _______Foundation --.---------f__------ Prop. Line ----------.-----•-----! f �, LEACHING LINE [ ] No. of Lines _--- ---------------- Length of each llipine��.... Total Length ...-_.473—/6 'D' Box ._ -_ Type Filter Materia5 `_'_Depth Filter Material ---- _ .,�CA4,.......... , Distance to nearest: Well ...--.............. Foundation _______...-.-___-...-- Property Line �__._-.....__._._.__ SEEPAGE PIT [ ] Depth -------------------- Diameter ._.------------- Number --------.------------------- Rock Filled Yes ❑ No 0 Water. Table Depth ----- -- ---------------------------------------Rock Size -------------------------- ---- Distance to nearest: Well ------------------------------------- Foundation ----------.---- Prop. Line ..._.--------__ __ � REPAIR/ADDITION(Prev. Sanitation Permit# ... ~_�✓,( _ ------------------- Date _.-� --__1 �� __j Septic Tank (Specify Requirements) ------------------------------------------------------- T Disposal Field (Specify Requirements) .7+ ------Z^ -------A4 5-g--- ----- (Draw existing and required addition on yfiverse 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 beco ject to War n' pens tion laws 'f California." Signed r Owner BY - ------------------------------------------------ ------------------------------------------------ Title ---- ----------------------- ----------------------- ------------------ '! (If other than owner) FOR DEPARTMENT MSE ONLY APPLICATION ACCEPTED BY - f -- - -----__ DATE _�'-- ___-__ _--6% ----_ BUILDING PERMIT ISSUED -------------------------------------- --------------------------------------------------------- ------------------------------------------------------ DATE --------------------- ADDITIONAL COMMENTS ------------------------------------------- - --------------------- ------------------------------------------ ------- --------------- ------------------------------------------------------------------------------------------------------------------------ --- - ----------------------------- ----- - ----- - Final Inspection by: ------ ----- --- Date --- SAN JrVAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M