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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------- ----------- 7S_ — .s ' Permit No. _____ (Complete in Triplicate) -------------- 0 -- '-- ------------------------- This Permit Expires 1 Year From Date Issued Date Issued 3- ----�---- _____-_____________ ---------------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wok herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regul tions: JOB ADDRESS/LOCATION _P77_73_-__S__.____.6©N= ---------F P,---------- -------------CENSUS TRACT __ _................. Owner's Name I-�}I L�-I-� -----__�__�l _ 5 n1_y E'/ 1. -M— -----Phone F5_0 � ,. / Address --------- 5_0-- - '°------CTR//�744 m .-------R D-------. City -----�&- - -------- --------- Contractor's --Contractor's Name ----1 U1✓N_F------------------------------- ---------------------------License # ------------------------ Phorre -------------•--------------- Installation will serve: Residence 2.6artment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -- ---------------------------------------=- Number of living units:__________ Number of bedrooms-----3_____Garbage Grinder s_ Lot Size _ G=G'A-G' - // / Water Supply: Public System and name ---------------------- ------------ _______ _____-______,__ __.c_---- ______-_Private Character of soil to a depth of 3 feet: Sand❑ Silt E] Clay E] Peat d Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ 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 seepa pit permitted if public sewer is available within 200 feet,) ,E PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size_7_ XIC___X__7_.------------ Liquid Depth ._ --------------- ..... .i Capacity -1 ------- Type _T Mater+al `CRTNo.r Compartments ------ __�-._. J0 istance to nearest: Well ------l,!9G __'t___�_.____•Foundation ._.t��______"^___ Prop. Line ._.. —� f J LEACHING LINE [ No. of Lines __�___________ Length of each line___.��_____________ Total Length __,_217............. V D' Box _ Type Filter. Material _{► ----Depth Filter Material ------ ____________ ------- r Distance to nearest: Well __________ Foundation ______ Property Line ................. SEEPAGE PIT [ ] Depth ____________________ Diameter ______________= Number __________________________ Rock Filled Yes ❑ No i❑ . Water Table Depth ------------------------------------------------Rock Size ---------------- -------------- Distance to nearest: Well ________________________________________Foundation -------------------- Prop. Line ...................... Q► h REPAIR/ADDITION(Prev. Sanitation Permit# _______ ------------------------------------ Date ______._______-_______________-•_-1 1 SepticTank.(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 signatu a certifies the following: "I certifyPtin a ormance o the work-for which this permit is issued, I shall not employ any person in such manner as to becs je orkm 's'Compensati.on laws of California." Signed - 1`-------------�t /`� Owner BY --------------------------------------------------------------------------- ,/� ` ------- Title _ -- -------=------------------ ------- ---------------------------- (If other than owner) n FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- .�1-C�-`---------------------------- ---------------------- DATE ----. _'_..--- 7 BUILDING PERMIT ISSUED ------- ---------- ----------- DATE ----------------•------------------------ --------------------------------------------------- ADDITIONALCOMMENTS ---------- --- -- --------------------------- - -- - ------ --------------------- --------------------------------------------- --------- ---------------- --------------------------------------------- ------- - ----------------- -- -- --- - --- --- ------ ----- - -- - ------------------------ --------------------------------------------------- ------------------- -- ------ ---- - - ---------------------------------------------------------------------------------------------- ---- ------------------------ ------------------- -- - rj _7F j -------- Final Inspection by -- ---------------------------------------Date --------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M