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FOR OFFICE USE: ? o APPLICATION FOR SANITATION PERMIT /V -� Permit No. ._7f�` 7/7. ------ ------ (Complete in Triplicate) t� /7 2--�3--5t - W" This Permit Expires '1 Year From Date issued Date Issued __.a_��- -7 V---- ------------------•------------ tall the work herein Application is hereby made to the San Joaquin Local Health District for a permit to construct and ins described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Re ulations: , • /oma:' . JOB ADDRESS/LOCCAATTIONr///?",eW-W-. :=-------------------CENSUS TRACT ------------------------• !� ` --.Phone ------------------------------------ C Name �-- -- -�- - -----•---------------- Address - __ ._ ._ 7f __ -------------------------- ----- City c ` Contractor's Name --C. /t �[ � � License # �� - Phone Installation will serve: Residence ❑ Apartment House❑ CommercialXTrailer Court .;❑ Motel ❑ Other ---------------------------------------•---- C Number of living units_____________ Number of bedrooms ------------Garbage Grinder ---------- Lot Size -- g-- frivate�-F�.S _G Water Supply: Public System and name ----------------------- Peat Sand Loam ------- ---_- Private - ---------- � Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ Y ❑ Clay Loam ❑ ' Hardpan ❑ Adobe Fill Material __._ ------- If yes, type ---------------------------- I (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,) er PACKAGE TREATMENT [ ] SEPTIC TANK.[ ] Size------ -X___1Q___--------------------- Liquid Depth -----4r-4-.............. Capacity CapacitY �------ Type � r Material__ 4J_ - --- No. rt Compaments __�------ 1 y c .f � Foundation 0______________ Pro _ Line __._ _--_____.___ Distance to nearest: Well _.__-1 ..- 6 LEACHING LINE [ } No. of Lines ----------------------- Length of each line---------------------.------ Tata! Length --------------------------•- 'D' Box ----------.- Type Filter Material --------------------Depth Filter Material ------------------,------------•---------•- Distance to nearest: Well -------------------`--- Foundation -------------------- -- Property Line. ------------------•--• SEEPAGE PIT [ ] Depth ----Z— --------- Diameter ------ Number ---------Z1 Rock Filled Yes I❑ Water Table Depth ------6_157, ------------Rock Size -�� Distance to nearest: Well ------ tin ___fi`---------•- -Foundation __ , _- ---- Prop. Line -��---------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------------------ Date ----------------•----•------------) Septic Tank (Specify Requirements) ---- ---------- ------------- ------------------------------------------------ I Disposal Field (Specify Requirements) _____________ ----------------•--------------- ------------------------------------------------------------------------------------------ -------- -------------------------------------------------- ----------------------- ----------------------------------- -- --------------------- ----------------------------------------------------------- ---------------------------------------------------------------------------------- (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 becom ubject to Workma ' Compensation laws of California." Signed �fslF. -. C"'_ Owner • Title - ��—._ ----------------------- -------------------- - - - -------------------- -------------------------- Of" Y --- other an owner) FOR DEPARTMENT USE NLY /f APPLICATION ACCEPTED BY --- --- ---------------------------------- DATE -------- BUILDING ------17 BUILDING PERMIT ISSUED ----- --------- ------------ --- ------------------:�.- ------------DATE ----•-------------- ----•----------------- ADDITIONALCOMMENTS - ------------------------------------------------------------------------- ------------------------- r�d -- - -- ------------------------ - -- ---- --- --------------------------------------------- Final Inspection by: -----.Date ----------- ----------- ------- -- to SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM