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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ---------------------------------------- 4} (Complete in Triplicate) Permit No. .7z-_�r______. __________ This permit Expires 1 Year From Date Issued Date Issued :_ _ Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein; described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . p 1 ------��--�-!_M 96� SUS TRACT _ " -7� Owner's Named 1u� C-�l�i. --Q J..__Phone .7023 --- - --- ------ .-- Address C?'Y1-�e_jr.-- � C�yyd - -------- -- --------- CityaG q �_----------------------------------------------- Contractor's Name _____ �_l�l�+_xs------ �_ 1 ________________________License # tz�,-�-A6' Phone- Installation honeInstallation will serve: Residence ❑ Apartment House❑ Commercial�❑Trailer Court Motel ❑Other ------------------------------------------•- Number of living units:__ ._ Number of bedrooms ___,;___Garbage Grinder A. Lot Size -----------: Supply: Public System and name ----------- --------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt p Clay ❑ Peat❑ Sandy Loam Clay Loam ❑ Hardpan ❑ 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 side.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ I S q SEPTIC Liquid Depth ---------------------------- Capacity Type _ ___ _ __ __ aterial__� .�o�o. Compartments --- ------- Distance to nearest: Well -CC`/__ __--------------------Foundation ------ Prop. Line w 1 LEACHING LINE No. of Lines Length of each line-_49.0 g [ ] �---- Total Length _-_- Q - - ---- ---- 'D' Box __��._ Type Filter Material ----------- __ -Depth Filter Material ------` Distance to nearest: Well _______— Foundation ---------- -- Property Line _.____r---.M_,._ SEEPAGE PIT [ } Depth _ _ Diameter _ _c- ❑ ------------------ _- - --____-- Number ------'----------=_---____-- Rock Filled Yes ] No Water Table Depth ---------��_l e �° r---------Rock Size ----f 4-i.------------------ ll Distance to nearest: Wel! ----------`-----------------------Foundation _._ ------ Prop. Line—___-_--- REPAIR/ADDITION{Prev. Sanitation Permit C# --------_----------------------------------- Date _____-__.-_---_.._..___.__________) SepticTank (Specify Requirements) -------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------------------------------------------------------- ' 1 -------------------------------- ----------------------------------------------------------------------------------------------------- ----------------------------------------- ------------------------ ------------------------------------------------_______________________________________________________________________________________________ E (Draw existing and 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, I shall not employ any person in such manner as to hecom hject to Work 'Zm_p=� laws of California." Signed -------- - ---- -- - -------------------- Owner BY ---- c/tl�`t� -------------------------- -Title ------ ...j (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --------------------------------------- ----------------------------------------------------------- DATE -----------------------_ BUILDING PERMIT ISSUED ----------------------9---- -- ----------------DATE ------------------------------------------- ADDITIONAL ------------------------------------- --- j ADDITIONAL COMMENTS ----------------------- - = I ------------------------------------------------------------------- - - -------- ------------ - --- ---------------- V,_ ----- ---- -- - ---------- ---------------- Final Inspection b ��°--- " eV---- ------------------------------------------------ Date 7 _7 -2y------ ---------- r J --------=------- SAN JOAQUIN LOCAL HEALTH DISTRICT '� E. H. 9 1-'68 Rev. 5M {