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FOR OFFICE16S7E: C �f )* ur ` ',APPLICATION FOR-SANITATION PERMIT G =..7.v------- --------- j ti w-v�-- . s F #Complet Permit No. - e in Triplicate} } '' Date Issued X77 7D ---------- This Permit Expires 11 Year From Date Issued Application is hereby made to the San Joaqui?r oca�H alth District for a permit to Yconstruct and install the work herein r described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �'? / c?`�, f ----------------- 1- f--'- .. CENSUS TRACT Owner's Name ------------ l V.-- a ,tiJ-----------------------------------------------------------------------------------Phone ------------------------------------ Address ---------------- nn I I I Contractor's Name ______�p_.t. _ � License # l l' 1�one ---- - - --- "--a --- Installation will serve. 1 Residbrice Apartment House❑ Commercial:[Trailer Court .❑ tY : Motel ❑Other -------------------------------------------- Number ------------------------------ -- -- Number oaf living units..- Numbe+ of bedrooms._-------Garbage Grinder . !V- Lot Size _Q_L= C. ',_.---....._ Water Supply: Public System and Warne ----------------------------------- }-- Private, Character of soil to a depth of 3 feet: Sand'rd ❑ Silt❑ Clay E] Peat❑ 5and L� c,4r 1 Clay Loam ;❑ / ' Hapan E] Adobe Fill Mgre�,ial - .-- - 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,) V I . � l R PACKAGE TREATMENT [ SEPTIC TANK X Size--- ,__X__ _ ------------------- Liquid Depth --_4a� --------------- l CapacityNo. Compartments ----�___-_•-:-_-- Distance to nearest: Well 46- &-- ________.______Foundation .-,e' -----._-- Prop. Line _----- LEACHING LINE No. of Lines .�........_.__ Length of each line___, ------------ Total Length ----_-___-___.- 'D' Box &_4. Type Filter{Materictl-�� Depth Filter Material � �P- ----------------_--,.-_---__- Distanc to nearest: Well _ ''_`___ _'_ Fou`nd{.ation rKO ___ Property Line. 1 ----------- SEEPAGE PIT ] Depth p _�--- Diameter __1 Number _.-__ Rock Filled Yes ' No Water Table Depth `J ` -------------->--------Rock Size f ------------- Distance to nearest; Well ----i---11_1�-.---------------Foundation Prop. Line _ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------------ Date ---------------------------------- SepticTank (Specify Requirements) ------------------------------------------------------------------------------------------------------------___--------------------------- Disposal Field (Specify Requirements) ---------------------------------------------------------------------- ----- ,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 fol#owing: 1 ,- "I certify that in the performance of the work for which this permit is issued, I shall not employ any peV In such manner as to become subject to Workman's Compensation,laws of California." v Signed -i--- # ---------------------------- Owner BY ?0than ------ -Title ---- � �' ---------------------------------------- (if - ----- -- ---------- (Ifowne + r .' TMENT USE ONLY APPLICATION ACCEPTED BY - DATE --- �`x' BUILDING PERMIT ISSUED --- i _ --- ---------------------------------------=--------------DATE ---------------------------------- ADDITIONAL COMMENTS ----- - ------ - ---------------------------- --------------------------------------- ------------------------- --------------- --------------------------------------------- - --------------------- ---- - -- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ - --------------------=-. -,rte-- -- - ------- - -- -- ----------------- Final Inspection by: ----- ------ -- r ----- - - .:--•---------------------------------------Date f C� SAN 'J,Of�QU'I�N LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M