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FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. _7,-. ,; 6 p p This Permit Expires 1 Year From Date Issued Date Issued ___ ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application i) made in compliance with County Ordinance No. 549 and existing Rules and Regulations: �7 -7 A) :"t 4,f cc a)AI let, J 8 ADDRESS/LOC / /� / y �..`�� -y- -- ENSUS TRACTOwner's Name ---_ -- �'ZJ`C -- �� P one Address _-I917L.C' -----------`I'� i-----. CityContractor's Namezc�= /- - I�---- L2,----.License # � ~ tYPhOnE ---------------------•---_-_ _ Installation will serve: Residencv[�Apartment House Commercial Trailer ❑ ❑ Court ,❑ Motel ❑Other ------------ Number of living _._ units:_ ______ Number of bedrooms ______Garbage Grinder __-.- -- Lot Size ____�a-----�_ --- --_---_.- .� Water Supply: Public System and name ------------------------------------ _---______Private IRN Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan Adobe M Fill Material ------------ If yes, type ---------------------------- (Plot ______________________(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 ublic sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK '.' Size_ t ! r { 6 V ✓ -1-- r ------ Liquid Depth Capacity)�0 C'- Type�-___ Material--��-1c-C�. No. Compartments Distance to ne est: Well --------_,�--------------------Foundation ----- - --------- Prop. Line _._--�_ :.--•-_-- Y LEACHING LINE ] No. of Lines _-____!____,_________ Length of each line----------C_P0.._`-___ Total Length ----- 'D' 8ox�------ Type Filter Material ___--S__fDepth Filter Material -__ �_Cr �� __ - • - ----•---------••-•- Distance to nearest: Well __-_ ------------ Foundation ` - �-�------- --- Property Line .__;.S':~------------ _ SEEPAGE PIT [ Depth -- Diameter No p -- ------ - ---_�-�---. Number -- ------- ------- - -- Rock Filled Yes � Water Table Depth ---------- �� f---------- it .. Rack Size - ---'--- ----- Distance to nearest: Well _-'________r=_P_©-----------------Foundation _-_� � ------- Prop. Line -------------- -----•- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------___ ___ ------' Date ) Septic Tank (Specify Requirements) ----------------------- - ` C 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California.- Signed alifornia."Si ned ----- Owner By --------- ----- ------- - r�: 2 Title _`�G- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._ _ _. -------------------------------------------------- ----------------- DATE - "'------------ B BUILDING PERMIT ISSUED ----- -- - --------------- --------------- DATE ------------------------- - -- - - ADDITiONAL COMMENTS ___ _ --------------- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------ -----------------------------------------------------------------------------------------------•---- ------------------------------- -- --- - ----- ------------------------- ------------------------------------------------------------------------ -------- Final Inspection by: __- ----------- ------------Date JOAQUIN LOCAL HEALTH DISTRICT tl}t} E. H. 9 1-'68 Rev. 5M