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FOR OFFICE USE: wkt� APPLICATION FOR SANITATION PERMIT -------------------------- pl— 7/ (Complete in Triplicate) Permit No. __--73�--_._---- _______- ---------------------------------------------- This Permit Expires 1 Year From Date lssu 14,41 Date Issued -�__ ____________ Application is hereby made to the San Joaquin Local Health District for a per it to construct and stall t work herein described. This application is made in compliance with County Ordinance No. 549 and existing les and egulations: JOB ADDRESS/LOCATION ._) _7. ___ __..' f' � fJ ___._.___.._---------------------------CENSUS TRACT -------------------------- Owner's Name _ Q� �!i.�.f9�� "�� ------ ---------------- -------------------Phone --------------------------•-•------- SrT`. Address -7 /l1L`�' = ------�"-- ------------ ------------ City / t"t' Contractor's Name . ------------------------------------------------ - --� -A--- --- -Qd�.f" - - License # ,�.f�'`d-�-�----- Phone -------------------•---•---••- Installation will serve: Residence ❑Apartment House,❑ Commercial NTrailer Court [I y Motel ❑ OtherQ�� _- ��' Number of livingun ---- Number of bedrooms __ _.--Garbage Grinder 1� --- Lot Size /Wpir-------------------- Water Supply: Public System and name -------------------------------------------- ------------------------------------------------------• Private-9- Character of soil to a depth of 3 feet: Sand'❑ Silt:[] Clay ❑ Peat 0 , Sandy Loam g Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Matetial If yes, type -t------------------------- (Plot plan, showing size of lot, location of system in relation+to wells, buildings,+etc.7-must be placed on reverse side.) NEW INSTALLATION: (No septie'tank or;seepage pit permitte`d'if ub(ic 'sewer i`s, jva'labfe within 200 feet,) PACKAGE TREATMENT [ ] 'SEPTIC TANK';' )/6�1*90 r �' ze}_f__ _ �X_� _ `.___?_•;-Ptd_ Liquid Depth _ � __..__,_..__ .,7 Capacity`_ _491a.._._. ___-1. Mc�teriol_ _:_ ' .. � f +�o. Compartments Distance to nearest:.`Well ..,31049 _f ___ . _ ___Foundation ____�„O________.___ Prop. Line __�______________ LEACHING ttOE No. of Lines%#_...� �,-__ _..,_x Length-ofach line_ � , �_� '�_�__r_ Total :Length ��-•-----------•---- D' Box [ . _- T,ypeFElter�Materia� Depth Filter �Ulaterinl � _____ --_---__ ----------------- - -- Distance to. nearest: We "-F '-�Fo6nd&46___�Zn ____.________ Property Line ............... SEEPAGE PIT [ ] Depth -------------------- Diameter ----------- Number --- -- -- -,_._;_----_-- Rock Filled Yes E] No C] Water .Table Depth ', Rock Size- -------------L-- ---- �� f Distance to nearest: Well ------------------- 1 .aund.at�iotad_------------------- Prop. Line -----------,.......... REPAIR/ADDITION{Prev. Sanitation Permit=# --_--_--.___-_'__________________�-- ifi Ir Date ---------------------- ------------ Septic Tank (Specify Requirements) _______________ _--_----'----`i_ w- ------- -------•-)- -•-_-..._ ------------------E 1 _____________ _E__ ____l ____.____________._ Disposal Field (Specify Requirements) ---------------------------------------------------------- -----------_ _ -_ _ _ ---------- -------------------------._ t -_ - I (Draw existing and required addition on'reverse side). ereby 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.thei-Sdn Jo6q'u n Locc€Lliealth District. Home-owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for whic-h-fhis permit-is issued, I shall not employ any person in such manner as to become subject to Workman'!Compensation laws of California." t , Signed --------------- --- r - ---F---- Owner - H- BY`' - -------------------- Title r other than Fq&DEPARTMENT USE ONLY,- � _. APPLICATION ACCEPTED BY ---- -- - y DATE BUIL61NG PERMIT ISSUED --- ------ i- ------------------ ---- `"+'- ------DATE ._ ADDITIONAL COMMENTS _____ _ ___ _______ _ -------------------------------------------- _____ __' ________=______=___________:___-:_______:___ __ _ :_ ___=:___-:_:_::___:_=_ _____ _ ---------------------- --------------------- �---- -- --------------------------------------- ------------------------------------------------------------------------------ ----- ---------- Final Inspection by: ------ --- -------•--------------------------- -----A------------------------Date 7f SAN J AQUIN LOCAL HEALTH DISTRICT k � E. H. 9 1-'68 Rev. 5M l