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FOR OFFICE USE: - � APPLICATION 'OR SANITATION PERMIT ...................... ............. ' ,. (Complete in Triplicate) Permit No. 7 _'l -? ...... This Permit Expires 1 Year From Date Issued Date Issued ..�y� � Application is hereby made to the San Joaquin Local Health District for a permit to construct anti install the work herein described. This application is made in compliance.with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... f,_53�--. ------ Name . • :;;� ............ w._-e.............. .. ......CENSUS TRAC.T.... Owner'sAA er r ccs,,? f -;;_: T ..................................Phone ... . .F. .....� Address /.l.Q---r... Y✓ h.�l� Y-e.:.::............•---•- a 1f.7�.�1-........_........... ..._ •------•---......City •.. Contractor's Name f AS y3 Y3 .__•,p•. .--- ---..PC�tr1s:�_..v�._SarrS..:....................... ....._..Licensed ._ Phone ......V� Installation will serve: Residence❑Apartment House f] Commercial❑Trailer Court❑ Motel ❑Other.:..._.... ...._ '� .. Number of living units:... --.-- Number of bedrooms Garbage Grinder O J3 0 ............ ..........._ Lot Slze .1....-•---X.......---•!.!�.o...... Water Supply: Public System and name .--jr). _Q1 _7�.O H - .. ................Private�❑ O Character of soil to a depth of,13 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ 1 } Hardpan o Adobe❑ `'Fill Material...:- .... If yes,type ............... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse aide.) LA NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC j ] Size-....-•................. - - ---- •-•--- Liquid Depth ........................... Capacity ------------- Material.. . No. Compartments Distance to -nearest: Well ............... . . ... ..........:.Foundation ..........__.......... Prop.,Line ........................ . LEACHING LINE [ ] No. of Lines ....................... Length of each line........ ......:._,.......... Total Length g ............................ D' Box- ...... Type filter Material -Depth Filter Material ............................................ Distance to nearest: Well ........................ Foundaltion --...................... Property Line ....... SEEPAGE PIT { ) Depth .................... Diameter ---------------- Number --- ........................ Rock Filled Yes ❑ No Q • Water Table Depth ----------------- --_---------•----Rock Size ... V Distance to nearest: Well .......................... .._.-_-..Foundation .. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ..................... . .. .. ...... Date ......... � Septic Tank ISpecify Requirements)................--------------------------• Disposal Field (Specify Requirements) --- *•r-i�iOl�. ./.Gw�1 Lrr t �'1 (1--- y Cr '� >' k........... ................... -- -_---_.----•--------•--•---------------- --- - J #Draw existingand required addition on reverse side) I hereby 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 the 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, 1 shall not employ any person In such manner as to become subject to Workman's Compensation laws of California.,, - Signed - - -.......... Owner 1 By .._ s "�+Ma,-Tor ----•-•- - . Title f other ikon owner! R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... DATE .,._.. .. ---------- ------- 1- ,� �,� BUILDING PERMIT ISSUED - - DATE .--..._.._.. ADDITIONAL COMMENTS . _-- ------------------ ------------------------- ------------- - .................................................- -------.............. - •----------------------. _._.-....... -- -•---------------- -••-- ----••--------- ----------------• -------------...,.--.----------- .....-..... .--- --.... Final Inspection'by: _. -------------Date ..... �%� • --4 c< EH 13 2 -68 ........... JOAQUIN LOCAL HEALTH DISTRICT 8/7� ..,3M-