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' —FOIA OFFICE USE: APPLICATION FOR SANITATION PERMIT r ---------------I-------------------- -------------------- t 4 Permit No. 7� - •-d .,. _,: .... (Complete-in�Triplicate)-M^ --�^� w� .- ..._--.-c , ----------------- P _ z G 7 - --------------------------------------=--------------- -- This Permit Expires 1 Year From Date Issued Date Issued ___ ________________. Application is hereby made to the San Joaquin Local Health District for a 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: L JOB{ADDRESS/LOCATION � �� _ � � CENSUS TRACT S_ ----.----•------ 1 _Pho ----- /5 Owner's Name f1_ __.� . - ---- k --- ----------- {----- n�� Address .4-40?--- ---------- City - - .` Contractor's Name �_ ----------License # 1_49P471 1 Phone ° 0 Installation will serve: Residence Apartment Housed Commercial ❑Trailer Court Mot f bedrooms - --------G�------------------------- Number ----------- -- - --- ( I Number o ❑ - �rbage Grinder _ Lot Size �x-4ako----------•-.-• Number of living units:-.---I Water Supply: Public System and name - --------------•------------ --------------------- ------------------------------------------------Private El •.,� t ` i 1 � Character of soil to a depth of 3 feet} Sand'R Silt❑ Clay 4❑ Peat❑ Sandy Loam Clay.Loom;❑ ` Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ------------------ l- (Plot�plan, showing size of lot, locafion of system in relation Oto 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,) `t E [ ~~o� {,] O �_`] J`_�X--�� s = Liquid Depth _, iZ ----- PACKAGE TREATMENT CaPa city _/2�K-'-_--- Type -tVe-e-7 e,I Material_ _._._. No. Compartments ________________ t Distance to near s#: Well Foundation --------------------- Prop. Line ___/_4_ ------------ LEACHING-LINE _ __----__LEACHING LINE No. of Lines '. .____ Length ofeach line._- -�ap Total Length ��r f D' Box _- --.- Type Filter Material __ FOCR--_Depth Filter. Material ____��_��___________________________ s 1 _ �- r �_ Founddtion,'--� `#-- --�--'l'roperty�Line. ________________________ SEEPAGE PIT Depth Distance to nearest: almeter �_-______ Number - ----------- ---- Rock Filled Yes ❑ No I❑ . , � � p II , Water Table Depth __ ----------------------- Rock Size� _ ____.___-______________ ------ --------------- 4 s q -- - Prop. Line ..__Distanceto nearest: Well ---------------------- --------------Foundation ' - -------- ------------ --�-_`.-. ------------ D ------------------------- REPAIR/ADDITION (Prev: Sa nitation._Permit# ` ate --------- Se tic Tank (S `cif 'Rquirements) ----11 N � , ; ------------------------- p ` -Disosal Field. Specify Regviernents) -------------------------------•--- -- ------------ a I -------- --- -- v { - ': —6-(.Draw existing and required''6 ddition on reverse-side) I hereby certify that I have prepared this applicationand that the wark will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations f.-�Ithc 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 become subject to Workman's Compensation laws of Cali �ornio." Signe ` __- Owner ---- -'------------------------------------ ---_. Title 6��---- ----------- _ _ ��f other than owner] , ',e' . 4 �E I c+ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----s ------------- -------•---------`--------------II-------------------------------------------. DATE __K�`� �'� ---------------------- BUILDINGPERMIT'ISSUED ------------------------------------------------------------ ------------------------- --------------DATE ------------------------------------------- ADDITIONAL COMMENTS ________________ __ R ' -------------- --------- - i - l ------------- - I y'---------------------- -------------T---- --_---- Il--------------- --------- --------- Y Il ---- --- �'• Final Inspection by;`. - - -I�� .------------- {------------------------- -----------.Date -------- �----- ------- -- -------- < SAN JOAQUIN LOCAL � � HEALTH DISTRICT " E. H. 9 1;`68 Rev. 5M 7� , c1 1. +1 ,