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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITj Permit No. 7_Z_=---J----2 d ----- ---------- ------------------------------------ {Complete in Triplicate) --------------------- ! Date Issued ` "2-s- 7 Z- This Permit Expires 1 Year From Date issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOC TION /00-&-4.---A' Qfx1 7� �----/�-d------- --•------ - ------CENSUS TRACT .----------- tr Owner's Name ---------� Y �----------- -• ------------------------- ---- -- - - --t------------------ ----------------- Phone __931 -1-7 City Address -------------------- License i -- -------------------- Phone ---------------•-- ------- r Contractor's Name + installation will serve: Residence.[Apartment House-E-1 Commercial ❑Trailer Court ',❑ Motel [:] Other ------------------------------------ Number ------------- -------------------- Number of living units:---- Number of bedrooms ___ ----Garbage Grinder _ .____Q.- Lot Size --- -- ------- -- - - ------- -- ----------------------------------------------- Private [+� � Water Supply: Public System an name __________________ ______ - - Cla Loam r Character of soil to a depth of 3 feet: Sand'[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Y 2' Hardpan ❑ Adobe'❑ Y Fill Material _._-_.._.___ If es,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 puttblic sewer is available within 200 feet,) Q PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size----------}------------------------•------------ Liquid Depth ------------•-------,••--- `lMaterial______________________ No. Compartments Capacity -------- ---------- - Type ----------------- . f Distance to nearest: Well -----------------------------------•Foundation ------------------ -- Prop. Line ---------- r Length of each ;line--------------------- -Depth Total Length ----------- ---------------- LEACHING LINE [ ] No. of Lines .-,..__________________ Len g t -------=-------------------•--- 'D' Box __.__._.-- - Type Filter pth Filter Material ------------- Distance to nearest: Well ____-______________ --- Foundation ------------------------ Property Line -------•--------•-•--- Q ,`� Number ---------------------------- Rock Filled Yes ❑ No SEEPAGE PIT [ ] Depth -------------------- Diameter ,--------------- Water Table Depth "" -----------Rock Size ----------------------------- ------------------------------------- f stance to nearest: Well ---,- --•-------- Foundation -------------------- Prop. Line -----------•---------- L { • � �_�__��------------ date .---------�-----•-----------------) REPAIR/AD TIO Prev. itation Permit r# __-- - --- y I _ I------------- - ----------------------------------- --------------- -------------------------•- 7Tank Specify Requirements) - --- sp,osal F' d (Specify Require ---------------------- = - ---t� W- - ----- --- - ------- - ' -e% --------- -------------------------------------------------------------- -------------------- ------------- ---- ---- - (Draw existing equired addition on reverse si e) I hereby certify t at t haveep�red this applicatiand thatithe work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of t o San Joaquin Local Health District. Home owner or licen- ' sed agents signature certifies the following: rr + C.9 "t certify th tin the performance of the we0f which this p ssued, I shall nat employ any person in such manner as to bet subject to o an's Compensations of California." Owner Signed _ ------ -�I/��2-� � �7 le ---------------------------------- ------------- ----------- --- - (If other than,owner) f `7 USE A Y - DATt= ---,1111 -� APPLICATION ACCEPTED BY --- -- ----- - -- - - - -- -------------- BUILDING PERMIT ISSUED _____- ------------- DATE AD ITIO AL COMMENTS --_. - ---- - T_ - - ----------------------------------------------- /AL `; , 4 - ------ ------ - - ---_--_----------------------_-- . -�-_ �j��C --- --- ------ --------- ---- _ __ -'--------- ------- -- - � ----Date ------- ---- ---------------------- Final Ins etion b - J JOAQUIN LOCAL HEALTH`DISTRICT E. H. 9 1-'68 Rev. 5M .l`