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FOR OFFICE USE: G ��o _ n �, APPLICATION, FOR SANITATION- PERMIT - .--- � ------ ---------- y Permit No. 7U— J I , (Complete in Triplicate) ---------=-------------- a--------- _ This Permit Expires 1 Year From Date Issued Date Issued z " Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOBiADDRESS/LOCATION .---.FQ ----:------�_----WW—Y---- - ---ST NJ--l� -EE _CENSUS TRACT ---------------- Owner's Name _,49/100- /A/0 ✓vjl A'--------------------------•-•- ------ ---------------------------------------Phone .----------------------------------- Addess _ 14 T � - ' r .Cit Y -------------------------------------------------------------------------•-- -- Cont'ractor's Name i - --�------9--6---- ------- -- ` SLCLicense # ----- Installation will serve: Residence �partment House-E] Commercial:❑Trailer Court ❑ f' Motel ❑Other ------------- ------------------------------- Nu0ber of living units------/----- Numberr'of bedrooms _,1_-_-_-Garbage Grinder ------------ Lot Size -------------------------------------------- Water Supply: Public System and name --ei`Yli-l .:�E Private ❑ Character of soil to a depth of 3 feet: Sand"[] iSilt❑ `Clay ❑ Peat❑ Sandy Loam i] Clay Loam ❑ �.. r "' Hardpan ❑ Adobe ;K 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'[jK' �� Size " -------------------------------------- Liquid Depth -------------------------- Capacity --------------------- Type_ ------------ Material-_---_---------------- No. Compartments 41 f Distance to nearest: Well -- -------------------------------\.Foundation ---- - Prop. Line ------------------- LEACHING __.---- _-.---LEACHING LINE [ ] No. ff:6ines ---'--^ak _ .-__ Length of each line__________________________ Total Length v �,DBox -: __.- Type Filter Material --------------------Depth Filter Material _- - _ - ` Distance to nearest: We11"_'" "___"" _" ""'Fo�ndatian""' "_° ___________ Property Line. ------- SEEPAGE NT [ ] ,"Depth -------_ Diameter ---------------- Number ------.----.---------------- Rock Filled Yes ❑ No i❑ - "Depth ------ - - ----=--- - ------- -----•--------Rock Size - � - - -- ----------- Distance -• -- Water Ta e ` Distance ton `` __--...Foundation ----------------- -- Prop. Line ---•----..___-. wrest: Well - -- --- --`�- ---= --------- ....... DITION(Prev. Sanitation Permit# ---------------'--------------------------- Date ------.•-<i_'................_.._. REPAIRfAD _ _ _._ Septoc Tank (specify Requirements)f - ------------ ------------------- -- Disposal Field`(Specify Requirements) 50.._,__ ------- -----------------t -- ai - -------------- ---------------------------------------------------------------------•---------------- - ------------------------ - hereby certify that I have preparedi'ihis application and that the - 4 Draw existing and required addition on reverse side - { work will be done in accord ance__with_San._Joaquin County Ordinances, State Ldws,%_nd Aules•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 beco subject to Workman's Compensation laws of California." i Signed ' ..._.__.Y..�. � -- - ..s ------------- ------------------------------------ - Owner BY = Title --'�------------------ - --------------------------------------------- (I other than owner) DEPARTMENT'-ISE 'ONLY..._.—,- APPLICATION ACCEPTED BY -- ---- -------------------------- -------------- -------- -- DATE .------ G---------------- BUILDING`"PERMIT"1SSClED --_—K-- - - - " - -_ ADDITIONAL COMMENT v------------ t Final:Inspection by: ___-. ---------------Date ------ - = p--_-- t, N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M k