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FOk OFFICE USE: APPLICATION FOR SANITATION PERMIT --------- ----------- -------------------------- ..- Permit No: - 7-��----- (Complete in Triplicate) ---------- ------ 7.-3.. 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 is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .--r �-- - ----- ---44Pr/ /a-.---A&/W- �4010CENSUS TRACT -------------------------- Owner's Name ---/ A_116 �4J0---------------------------- ------------ ----------------- -------------Phone -01 Address - -1—Azs.eye, ---- -- Contractor's Name _� % -, ,-------.License # f 3Phone _45-V40_3_55P Installation will serve: Residence partment House❑ Commercial :❑Trailer Court i[] Motel ❑Other -------------------------------------------- Number of living units:-I-------- Number of bedrooms -3 Grinder ------------ Lot Size _.LJ -C---- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam .❑ i 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'[ ] Size---4'�_X__.47�---�_�-___ ____ Liquid Depth ._�__��______,___. Capacity/ ;;�4_______ Type lar4` Material___ ,r *o. Compartments Distance to nearest: Well ____ •_______Foundation -------- --- Prop. Line ___ LEACHING LINE [ ] No. of Lines -----Z--------------- Length of teach line-------7 -------------- Total Length _ V-0 _..._._:..___. e 'D' Box &@� ---- Type Filter Material _� _��___Depth Filter Material ----/-.47 Distance to nearest: Well ---/0-0----------- Foundation .../ ------------- Property Line --------- ' t SEEPAGE PIT [ ] Depth _______________ ____ Diameter ---------------- Numbe; ------------- Rock Filled Yes ❑ No Cie Water Table Depth --------------------------------- -- -----------Rock Size -------------------------------- d Distance to nearest: Well _______________________________________Foundation ---------- ---------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date --------------_____-__--__-_______) SepticTank (Specify Requirements) --------------------------------------------------------------------------------------------------------------- -------------------------- DisposalField (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 g man's Compensation laws of California." Signed ___._ as to ecom lett to Workman's ��- Owner BY -------------- --------------- --- --- ----------- Title __ - - ---- ---------------------------------------- [If other than owner] OR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY . - -- DATEr/. = .. BUILDING PERMIT ISSUED ---------------------------------DATE -----------------------•-1-------- ----------------------------------------- ADDITIONAL COMMENTS -------------------- ------------------------------------------- - - --------- -------------------------- ----------------------- -------------------------------------------------------------------------------- ---------------------------- ----- -- --- -- ------------------------------------- - --- --------------------- ------------------------------- ---- ----- - ----- - - ---- - ------------------------------------------------------------------------ ---------- - - - - Final Inspection bY: -------- -9 --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M