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FOR OFFICE USE: � APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. 7� '__ 37 . ___--__-____-.--- 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 .-------- ---------------------------------CENSUS TRACT ___-________-_-____-_- Owner's Name v! Ph e ----------------------------------------------- / Address -----------------------------------�1 lI' --------------------------------------------- City -----. ve.- ✓_��---------------------------------- Contractor's Name --------------------0-(V/17 e.✓-------------------------------------------License # ---------:------ ------- Phone ------------------------------ Installation will serve: Residence KApartment House❑ Commercial []Trailer Court ;❑ Motel ❑Other -------------------------------------------- , Number of living units:------l_-_ Number of bedrooms ----- Grinder ____'____ Lot Size __ G< -� -fj-16.T______________ Water Supply: Public System and name ------------------------------------------------------------------------------------------------------------Private 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 seepa a pit ermitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK.[ �0y Size____________________ q p --r Capacity fid _ . _ Type _:fie=_C.��Materii ---- --_ --- Compartments ____-z-- °a Distance to nearest:)Well __ _________________Foundationel __ Prop. Line _ LEACHING LINE No. of Lines ____- � _--- Length of each line____/__ Total Lengthh -_-_ _- _�.�____ D' Box .. __ Type Filter ateriap_rrq t Depth Filter Material 1_�1 � Distant to nearest: Well _ _ ___a_ `___ Foundation __ _ _.._______ Property Line __4 -../_'--..... -.... 7 o? Filled Yes No SEEPAGE PIT [ Depth ___ r _ Diameter ___ ____.___ Number _________ ____-__. _ Rock d ❑ Water Table Depth -------------- - -----------------Rock Size ---------- ------------ Distance to nearest: Well ------- -----------------Foundation ---_ Prop. Line _-__ _ 4___... O REPAIR/ADDITION(Prev. Sanitation Permit# --------------_----------------------------- Date ----------------- ________-___.__-) Septic Tank (Specify Requirements) _______ __________ _____ _ -_.,_ .___ ____.-__ ___----__ -------- ---------------- ---- - 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 become lett to Workman's Com ensation laws of California." F Signed - t t� �1-----721 ------------------------------------- Owner BY �er ------------------- Title ----------------------------------------------------------------------- owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------- 't --------------------------------- ------------- DATE --- 9. BUILDING PERMIT ISSUED - r -, DATE ---- y ADDITIONAL COMMENTS -�` dX l� � - .fP� - + __________________________________________________ _____ _____ ____ __ ___a____ --------- _____ -___ ---- ----- __Y. -_ -------------------------- - ________________! ____ ------------------------- - ------ __ --------- ----- ------------------------------------------I___ __ ----------- ---------- ----- __________ - --------- __ __ _ ---- --_�_._ ------------- __ -_--__ -- - __--- Final Inspection Y ection b `/t------------------------------------------------- ----- --------------------------------------Date -.0- --Y- -- ---- ----------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M