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FOR OFFICE USE: .............. _ .. . APPLICATION FOR SAN17ATION PERMIT y (Complete°n Triplicate) Permit No. .7 ......... _I . _ - 21....1 -_ .. . ....... ......................... '� Issued................... This Permit Expires 1 Year From Date Issu Ied ................... 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 Q-� Cl....N5. .19.M_c=..1W_t6CD' .AU ... .. ... .... CENSUS TRACT Owner's Name _.. . ..p.�.{,q.._....(,�..)p.L.(. f.�. ..{� ....... ................ .. .....Phone �16.� -.� .:.1.�...... Address _790, S 11Jk'1c�Iz .F.C)..._. .. ............ City Contractor's Name n !•L.kx ...... License # ._.. .........._. . Phone .... .. ...................... Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court Motel [] Other Number of living units: �_ Number of bedrooms Z......Garbage Grinder .. . ...... Lot Size .i C.YZEr9lfl ........... Water Supply: Public System and name ...................................... ...Private (� Character of soil to a depth of 3 feet: Sand o Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom 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 see ge pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size.. . ... -.. / r / .f---X...(q.m 1.... Liquid Depth ..... ...99,�...-.. J Capacity --f �.0-.4...- Type/ rf fvSio1....C.a.v1-C- No. Compartments ....../-.. D' tante to nearest: Well T . .-....Foundation ...1.©............. Prop. Line .......<a ........ LEACHING LINE No. of Lines . l < S Y�. . -__.. Len th of ea Ilne....._..... .. 0......... Total Length . . . .. . 9� / � " ��................ N D' Box .... T Filter Mat is ..........;1-- -Depth Filter Material 'i Distance to nearest: Well ..1 7�.... Foundation /G._.._f. .. Property Line ......r... ......... SEEPAGE PIT [ j Depth .... Diameter ................ Number _ .._ ............... Rock Filled Yes No Q Water Table Depth ...... _...................................Rock Size ............................. - Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... _ REPAIR/ADDITION(Prev. Sanitation Permit# ------............._-..................... Date ......_--...................---r-) _p .......... ............................. Septic Tank (Specify Requirements) .......... Disposal Field (Specify Requirements) ........................................................... .................-- ......... ......---................................ --- __._.._. ._.... ..................... . ...................................... ..........------........ ......_..........................---•-........................... _ ---- -------- ----------------------- ........ -.- ... .......... ... ........................................_.I....... . (Draw existing and required addition on reverse side) I hereby certify that 1 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 bec sle--t to 'rkman's Compensation laws of California." Signed .. ...- ... _... .......................... Owner By . ._ - ..... - .......... -------------- -------------------------------------------*---------....... Title (If other than owner) _ D R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ..- .. . (? r- <r .r sl,�.. .. DATE BUILDING PERMIT ISSUED _ _DATE _ . _.. _...ADDITIO•'►L COseMFNTS ,- '/ •: _.-._...... — .. ... . �. Final inspection by: ....-... .............._..._..-...... ........... Date « - FH 13 2!t 1-68 Rev• SM SAN JOAQUIN LOCAL HEALTH DISTRICT /8/711 3M