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FOR OFFICE USE: `APPLItATION FOR SANITATION 'PERMIT Permit No. 7- -2-: �-7- -4, 3-Q--2,N ffl!-V-Fr /() erm .(Complete in Triplicate) --------------------------------------------- Date' Issued 2--- --- --------------------------- This.Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work, he'rein described. This application is made in compliance"with County Ordinance No. 5A9 and existing Rules and Regulations:. -----------CENSUS TRACT ------------- ------ JOB ADDRESS/LOCATION ............C------ Owner's Name ------14A-11,11-7-?----------------;�------------------------ ------------------- -----------------Phone Address ..-/------------------------------------------------------------------------------. City --------- ------------------------------------------------------------- ------ ----------License # Phone _7------------ Contractor's Name Installation will serve: Residence E] Apartment House-[D1Commercial-:E]Trailer Court -;E] Motel E] Other -------------------------------------------- its.--- Number of bedrooms 17---- ---- ------------- Number of living un -6�Z_Garl�age Grinder Lot Size 4�-'f-42- ' / i - -- Water Supply: Public System and name ----------------------------------------------------- ----------------- ------------------------------ ----- - Private, Character of soil to a depth of 3 feet: , Sand'[] Silt 0.- Clay.E] Peat El f-Sandy LoaM^ El Clay loam Hardpan F-I Adobe F-1 Fill Material ------------ If yes, type --------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildii767,-'et-d.,,�m..-u%st,be placed 'on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK![ ] Size------------------------------------------------ Liquid:Depth -------- ------------------ No.. -------- Capacity ------------------ Type ------------- ------ Material _Compartments ..... ---------------------- Distance to nearest-. Well ---------------------------------------Foundation ------------ Prop. Line LEACHING LINE No. of Lines ---------- ------ Length of each line-_-----------------------` Total Length -----------------•---------- - ------- - 1, - -D' Box ------- Type Filter Material ---------------------Dept.h Filter Material --------- ------------------------------- Distance to nearest: Well ------------------------ Foundafionf------------------------- Property Line. ------------------------ SEEPAGE PIT Depth I--- ----------------- - Diameter ---------------- Number --------------------I-------- Rock Filled Yes ❑ No C Water Table Depth ---------Rock Size ----------------------------- Distance,to necirest-. Well ----------------------------------------Foundation -------------------- Prop. Line ---------------•------ REPAIR/ADDITION -------------- ------ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic Tank (Specify Requirements) -------- -------------------------------------------------------------------------- --- ---------------------------- --- -------- ---------------- Disposal Field (Specify Requirements) ----- -A71el,7 --V -------- ----------- ---- -- - - - - --- -------------- ---------- -------------- --------------------------------------------------------------------------------------------- ------ ------------------------ ------------------I------------------------- ------ ------------------------------------------------ ------------ ------------------------------------------------------------------ ------------- . .. - -1 (Draw existing and required addition on reverse side) I hereby certify that I have pre�pcirecl this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws,, and Rules and Regulations of the Son 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 issu!d1-4,gh�all`not employ any person in such manner as to become subject to Wo a an s Corn ensation laws of ColiFornia.�'--- Signed ---- -----------Owner—,, --------------- ---- ---------- - -- --- ------------------------------- By ---- ------- --------- ------------------------------------------- Title ---------------=--------------------------------- i -------------- --------------------------------- ---------------- (If, --er--t4a e- )rr) OR ARYMENT USE ONLY DATE ------------- APPLICATIONACCEPTED BY ------- - ---- --- - -- -- -- ------- ------------------------------------- ------------- ------DATE ------------------------------------------- BUILDING PERMIT ISSUED ---------- ----- - --- - --- -------- --------------------------- ---- ------------------- ADDITIONALSOMMENTS ---- ---------- --- ---------I----------------------------- ------------------------------------------------------------I- --�2 ?1. ' --- - 2�-- - ----------------------------------------- -------------------------------------------------------I-------- ----- --- ... ----- ---- ----- -- ------ - - , --------------------- ----------------- --------------------------------------------------------- ----------- ---------- ---------------------------- --- -- - ---------------------------------------- ------------ ------------------------------------------------------- - ------- Final Inspection by: . -Date ------ ------- ----- - ------------------------------------------------------------- ---------- ----------- ------------------- - ---- --- ----------- N JOAQUIN LOCAL HEALTH DISTRICT L E. H. 9 1-'68 Rev. 5M