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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- ------------- I // �'„� (Complete in Trip�cate} Permit No: _��--~- �______. This Permit Expires 1 Year From Date Issued Date issued ---- ------------------------------ Application is hereby made to the San Joaquin Local He Ith District. for a permit to construct and install the work herein described. This application is made in i h Z&,, ,,n Ordinance No 549 and existing Rules anj Regulations: JOB ADDRESS/LOCATION .- - --- ---------- --CENSUS TRACT -------------------- --- Owner's Name _ Ogq_p ri��Q 1 11 1 �� ---Phone Address ---- A Q- - 11&__4.t Cit y Z'TK -------------- Contractor's Name --__---__ t---- -. - HR�I '- --- �YG----.License # ______ ______________ Phone'7` 60� ---—--- Installation —Installation will serve: ResidencexApartment House❑ Commercial ❑Trailer Court :0 Motel ❑ Other --- ------ ------------------ Number of living units..---t Number of bedrooms __!,_____Garbage Grinder _-__-___ __ Lot Size -- Z r ----------------------- Water Supply: Public System and name --------------------------------- d=;'f r_______ 1�--.• ----------------------.---.-----Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .E] Clay Loam jX 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,) �ri PACKAGE TREATMENT [ ] SEPTIC TANK _ Size.- ^'= - -- ------------ - Liquid Depth ___-----------..__._______ Capacity (_2306----.-_ Typefq$ -'_ _ Nom' No. Compartments --._- Distance to nearest: Well _____________F ndation ---------- Prop. Line -------C-______._._._ tr LEACHING LINE No. of Lines _____I__________________ Lengthy of each line____ ---------------- Tota! Len th ----�.�-__ -------.. ef 'D' Box __________ Type Filter Material ___ .Depth Filter Material ---/__ ___________________________________ Distance to nearest: Well _�_0-rt-a_-___ Foun ation _.__--©_ ----------- Property Line ------ � � <4 __________ SEEPAGE PIT � Depth __ ___ ___ DiameterZZ______ Number -------I___ .____r_j Vz-- Rock Filled Yes �' No ❑ s Water TabDepth _____ ' '�____________________ __________Rock Size _,C/_��_�,1 ------- le ._ Distance to nearest: Well _ _ _ ______________________Foundation -------- Prop. Line -----.. -------.__--__ nn� R o REPAIR/ADDITION(Prev. Sanitation Permit# --------_----------------------------------- Date -----------------------_----------I SepticTank (Specify Requirements) ----------------- - --------------------------------------- -------- --------------------------------...--------------------------- Disposal Field ISpecify Requirements) .. --•� - --- — --------- ---- -------------- - - --------------------------- i ______________________________________________ _____________________________5____..__________---_--_ -------------------------------- ------------------_--------__________________________________________________________________________________-_____________________________________-__-____-_______.___.__________-- ._____--_-_________ (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 b su 'PctVWoman's Com a rtsa�'on laws of California.”P_Signed--`- --------- --- -/-� 141]S- l±C ------6varrer t By --------------- -------------- -f '�- ----------------------- Title --- -- ---- ------------------------------------------------ (If other than owner) DEPARTMENT USEZNLY' ! -7 APPLICATION ACCEPTED BY / . . ---�t--/--- - - - ------------ DATE -- 0 -/ �-------------- - - -- -- --- - - BUILDING PERMIT ISSUED ----f - ----- ----- --- ------ -- ---------- —n DAT ---------- �DDIT�ON,_L COM TS _.:_ 1 o fes►_ /eye > � -- - -- - -- ---- --------- J--- - ------ ------------------- ------------------------- -------------------- y M -s-�----- ---� ------ - / �►, 7I''---- ¢ � ---- - - ------ - inal Inspection by: - - ----- ---- ----- - ------------------------------------------ ----------------------------- --------- ------------------Date --- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1•'68 v. M