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{ FOR OFFICE USE: `,� APPLICATION FOR SANITATION PERMIT 7 Permit No. � - - (Complete in Triplicate) -------------------- ---- --- Date issued This Permit Expires 1 Year From Date issued _ - Application is hereby made to the San Joaquin Local -Health 'District fora 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: C�L� .1 -� - - - ---- - � •- CENSUS TRACT ---------------------- --his - -------------------••-- JOB ADDRESS/LOC 1V . ------1 J.� ^� __ _ __his---J--------Phone �tL Owner's Name ----- -------------lity ,,rr�� .�Aj------ ----------------------------------------- ------- Address t1,1_�-_ iX � - - - - License #.-/fv _;?7_1Zf'honeL Contractor s Name ------ X14 ra � Installation will serve: /Residence ❑ Apartment House 10 Commercial Court i❑ ` Motel ❑ Other ------------- -------------------------- -- ~s r--------•----- Number of living units:..:r "-- Number of bedrooms ------------_Garbage Grinder --._ ---r L t Size -> --- -- -Priva Wafter Supply: Public System and name -------------------- ---- - ---------------------------------------------- Clay to Peat Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3.feet: Sand'❑ Silt❑ Clay ❑ ❑ Hardpan ❑ Adobe Fill Material -------------If yes, type ---------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1_ NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer.is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK![ SSiii e.�_ lx�_X- -- =------------- --------- Liquid Depth --- - ------,- O [. _ Material- -_V - -.- -- -.-- No. Compartments zr.. .. ......... Capacity Type p ' Foundation _.- d-----------.Prop. Line ---- ---------- Distance to nearest: Well ____ .- ---------- LEACHING LINE [ No. of Lines ---------I________ -- Length of each�ine__._ Q_�_---- ---- Total Length .---- � D' Box __V0_ Type Filter Material 46-7)--__ -- ept Filter Material ____ __ __ _ _ � - Distance to nearest: Well __ ------- Foundation -- ------ Property Line -- --.-------=-•-- De Depth Diameter ------------- -------- Rock Filled Yes ❑ No 0 SEEPAGE PIT [ ] p ___ Number Water Table Depth ___ --- ell----- -------=------==-------------------Found..Ze --------------------------------- Distance --=----- -------------- ------ _ Rock Si - Distance to nearest: W b ation -------------------- Prop. Line --------------------- - f REPAIR ADDITION(Prev. Sanitation fi Permit#.-------- ----------------- 1----- --------- Date ----------------------------------) ----------- Septic Tank (Specify Requirements) -----------=------- - - -------------- ----------------- �.-�- - Disposal Field (Specify Requirements) '-----------'----- ' ----------------- ----'------------------------- -------------------------------------------------'--'--------------------- ---- - --------------------- L 1 ' -------------------- (Draw existing and required addition on reverse side) .. �_. I hereby certify that IAha ve 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- I sed agents signciture certifies the following:a t "I certify chat in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.`' -Signed -- --koer j Owner k. { ----------- ----- --- ----------------------- ------ ri,v `r• Title -----B ( n owner) FOR .DEPARTMENT USE ONLY . 7U--------------- ' .APPLICATION ACCEPTED BY _ -------------- DATE - { BUILDING PERMIT;155LfED. -------------- DATE ----- ------------------------ AbDITIONAL COWIMENTS``----------------------- ---•-- - _ - ---------- - ---------- r:. ----------------- -------- ---.. - ----------------- r __ -------- --'- - - --_ ,Date --------��=--�'�-- -------- - - Final Inspection by: — -�--------------- ------------- ------ --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 'E. H. 9 1-'66 Rev. 5M. a ` "