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FOR OFFICE USE: .. 'f 3 ` 3 � �_ APPLICATION P,FOR.SANITATION & -------- -------------------------------------------- Permit No. 7 -- ------ (Complete in Triplicate). N _ - -- =-- -------------------------------------= 666 __ _______________ This D Permit Expires 1 Year From Datb issued ate Issued _r 7� 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. and existing Rules and Regulations: , � n -�-o------- --. JOB ADDRESS/LOCATI --------- ------------------CENSUS TRACT --------- JOB ADDRESS/LOCATIP Name --- ------ ---`--Vt.J-` P 'r-ut ..�----- ------ -•- ----------------Phone ---�� --�-+ st�OE Address ----------- --------------- --- x City -----------------:---------------------- ....... Contractor's Name -------:-- ---2 t-� t--1------ 1� '--.-License # ---------:-------------- Phone ---'}C��.f"'17 �. Installation will serve: Residence Apartment House❑ Commercial ;❑Trailer Court i❑ Motel ❑Other ---- ------------- --�� Number of living units:...... ____ Number of bedrooms _.__2,,"G -:'4 a Grinder -_________ Lot Size ____-----_�W_---j�-___-- Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private 91 Character of soil to a depth of 3 feet: Sand'❑ Silt❑ 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 ' i Size------------------------------------------------ Liquid Depth --_------------------.----- i Capacity ------------------ Type -------------------- Material---------------------- No. Compartments .......... ' Distance to nearest-'VVi ll ------ ------------------------Foundation ---------- ----------- Prop. Line ---.-----------•-.-.-- LEACWING LINE [ ] No. of Lines a_______________ g �*- g -_- ---`Len Length each line---------------------------- Total Length .----------_-..---------___-- . 'D' Box ------------ iTypef Filer Material ____________________Depth Filter Material --------------------._______________-___--_ Distance.to nearest: Well- _______________5_____ Foundation ------------------------ Property Line, ------------------------ % SEEPAGE PIT [ Depth ______,__`__________ Diameter __________-___ Number ____________________________ Rock Filled Yes ❑ No ,0 . Water Table Depth ------------ ----------------------------------Rock Size ---------------------------- Distance to nearest: Well -------- `______________________________Foundation -------------------- Prop. Line _____.____--__-_-_____ REPAIR/ADDITION(Prev. Sanitation Permit# - ------------------------------------ Date ----------------------------------1 ` Septic Tank (Specify Requirements) �c -y-�--� - - Disposal Field t(- ecify R uirements) __-_ __ ,___ _ _______._ ._c_____ ___ _________ ____________________ _ _ _ __ _____ ________________-_-_-____________J.________________________ _______ __ ______ ___ ----------- ------- --`-`--� - ----------------- -------- ---- �- = (Draw existing a d req red 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-1aws, 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 become subje Workman's Com ensati.on laws of California." Signed 5 By -------------------------------------------- ---- Title __ ¢- 1 --------- �U�-rzc1 . -------------------------------------- (If other than owner) a.Y _ FO EPARTMENT SE ONLY APPLICATION ACCEPTED 8Y --- --- BATE 2 BUILDING PERMIT lSSUEp ------ ------------------------ - --- ------------- - == DATE = ....7... ADDITIo L COMMENTS`------------------- � . ----------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- --- -------------------------------- _ ---- ---- - - -------------------------- --- -- ----- -- -- Final Inspection by: ------ - ------------ - - -- - - -------------------------------Date -- _ /// SA JOAQUIN OCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M� i