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FOR OFFICUSE: APPLICATION FOR SANITATION PERMIT ---------- -------------=----------------- - . Permit No. -7 1-] 5 .9 in 4i;L_ . (Complete in Triplicate) I1Z 7 Date issued ___.._..`______.__. ---_-- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is madelin compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ------�---------- ---------------------CENSUS TRACT -----�---��------ [ ` I Owner's Name --------------- {�- --51-niA-5-=------------------=_----------------:----- ------- -----------Phone :.�� p _n'7-rc�_-�------ Address 1 Q<3.�- -------- U�� --------- ------------ City ----f lL°P� --------= ----------------------- _-- -1-- - =` Contractor's Name ----- Gt11V-E - -------------- - -- -----License # Phone - - - - - - -------------------- Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court l❑ 1 Motel-F Other -------------------------------------------- Number ------------- ----------------------------Number of living units:--- Number of bedropmis 3---____Garbage Grinder ---._.------ Lot Size _____________ ________ ___________________ Water Supply: Public System and name __ ---------------------------------------------------- ------- Private ®_ i i R it y ❑ y- Y _ . _CharacterTof soil-to..a_de th.of 3-feet: Sdanad1;.-. -Si y type p ❑ lt. • . ._Cla ❑� Peat.,.�--Sandy-Loam.Loam_ __,,.,„.0 a Loam.,❑ �„�- Hardpan ❑ Adobe ❑ Fill Material __ t if es, t e .--------------------------- (Plot ___._____ _(Plot plan, showing size of lot, Iocaton 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,) - r PACKAGE TREATMENT [ ] SEPTIC TANK:[ I Size--------------------- ------------- ------ Liquid Depth.------------.-.----------- Capacity ---- Type -----------fl------ Material----------------;----.`' No. Compartments -------------•• ---- d Distance to nearest: 'Well ------------------------------------Foundation------ ---------------- Prop. Line --------- ------------ LEACHING LINE [ ] No.-of-Line s_�____.____s ---------- Length of,each line_____ __________-t___.-_ --- Total Length ----------------.______-____ 'D' Box ---- __.____ Type Filter Material --._ ---------------Depth�'Filter aterial -------------------------------------------- Distance to nearest: ell ------------------------ Foundation _______________ ------- Property Line --- SEEPAGE PIT [ ] Depth _------ iometer ----------------.Number --__._----.--------- ------ Rock Filled Yes E] No 0 . Water Table Depth -------------------------------------------- Rock Size ---- _ R k S' e .1 ea ---fit �h.-7--1•---...--- • `~ --------------• - - -- -----��- ----- Date----.- - ----- ---------- Prop. Line _. - ---.T,?�.� REPAIRJADDITION(Prev. Sanitation Permit - •--------------) Distahce o nearetst: Well _____-__ Foun ation-_ Septic-Tank_ASpecify Requirements) '------------------ ------------- - --------------- ------ Disposal Field (Speci(yl Requirements) ---- ;p ,_ �' /hf;E t "TO-------------------------------------- F ----- '/X_ �`� tPi9 -------- 1T`---- -- - ---- ----- - -----I------------------------- ---------- ----------- - - - ... ------- ------------------------ Draw --- --- --------- Draw existing and required 'addition on reverse side)' I hereby cettify 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 Distrid. Home owner or licen- sed agents signature certifies ollowing: ".'d certify h t in a perfor an of the work for which this permit is issued;,-.1 shall nottemploy ar(V person in such manner as to bec a )ect to W r an's Compensation laws of California." ' Signed ` - -- ------ ! - ----- -- ---------------------------------------------- By ------------------------------------------ Owner --------- ` Title ---- -------L,_.__.__. _ __ ____ (If other than owner) FOR DEPARTMENT USE ONLY; APPLICATION ACCEPTED BY -'"----------. DATE ---- BUILDING-PERMdT ISSUED _ - ,-,________ = =- _= = =_ = - = - DATE..k__. .__. ----•- -------------- ADDITIONALCOMMENTS - -------- -- -- ---- -- - - ----- ------= ^----------=`-- •--•---------------- -- _�__ --- F•.. `ti;--------- -------------- ----- - -------------- -- ----- - -- �- =----------------- - ----}------- -----_--- - - -- - - ---- - ---- -------- - - -- - ------- - ---------- - Date Finallnspecti by: - SAN JOAQUIN LOCAL HEALTH 'DISTRICT !'1 �E.+H._9L l-'68 Rev. 5M