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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT --------------- -_ ________w________ ' ----------------- (Complete in Triplicate) Permit No. 7_Z_-_2 Z S -------------- ------ ------------ -- �,/{ � Date Issued .`�.�`/____�� --------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin.. d„L,Health [district• for a. permit to construct and install the work herein described. This application is made in compliance'.' ompliance with County 6rdinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION--- - ------ - - - --- ------- - ----- - - ------- -------- -----CENSUS TRACT -------------------------- Owner's Nam ----- -- ----- -------- - Phone// -�.7t � !Q Address ----R �1 -4 `---- 1g J� _IV" City --f>�C ------- At...................... Contractor's Name ---:_ - `----- - -------- -_-_.License # _/__jos'!_---__ Phone Installation will serve: Residence ❑Apartment House❑ Co 2 mercial ❑TrailorCourt i❑ Motel ❑Other _ t Number of living units:-a. Number of bedrooms *----_-Garage Grinder•-:./ _ Lot Size .f��-_. -- - -� ...... Water Supply: Public Syst and name ----------------- ------------------------------------------------------Private ❑ Character of soil to a depth7M feet: Sand❑ Silt❑ , Clay ❑ Peal E3 Sandy Lo4m,,-Dj Clay Loam ❑ a,.. Hardpan E3AdobeFill 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: ( � eptic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { 111�SEPTIC V,K,.' _ Size « s„7`s"_A 5_>e 4. -- - - Liquid Depth --------------- C 1ty j_�oQ _ Type Material No. Compartments �! _ t ------ Distance to nearest- Well .__ p--------- ___._.Foundation -_Q___________ Prop. Line __ ` ._..I'a ___-__ LEACHING LINE { ] Nr of Lines ��_ ------------ Length of each line �•� 7Total Length ,�_ _ .............. 'D't BoxType Filter Material 1' _. ppth Filter Material J-7-11 ----------- Distance to nearest: Well . _ ____.__ __ Fou tion 1-1-57-11 --_ -__-.-_ Property Line _140............... SEEPAGE PIT [ ] Depth _____ -__-___--_ Diameter ...... ber ._ --_:--.----------------- Rock Filled Yes ❑ No i❑ Water Table Depth -�--_; ---y----- -- --------------------_---Rock Size -----------------------•--- Distance to,near t.Wel! _.a---- --- ------------------------Foundation -------------------- Prop: Line ...................... REPAIR/ADDITION(Prev. Sanitation Perrot# ---------------- ___ __ ___________ Date -_---_.-_-_--__;____ --_--__-_-__) Septic Tank (Specify Requirements) ------- ----- -- --- --- -L------- -- ------------------------------ - ------ ----- ----- ------- --------- Disposal Field (Specify Requiremepts) .__:_. _ _-__ ____ -------------------------------------------------- -- ------------------------------------ - --------------- ------- ------- -------- ----- ------- -------- ---- (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 ;;hat ormance the work for which this permit is issued, I shall not employ any person in such manner as to becotVVorfcma s Co ensat' aws of California." Signed ------- ------------------- ----- -- --------- Owner BY ---------- - - ---- Jitle . ----- i - -- -- ------ -- - - -- -- -- --------------------------------------- (I her than owner) �FF�OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -- ----- --- ow-el --------------------------------------- DATE ------ PERMIT ISSUED ------------------------------------------------------- ------------- - - ------ ------------------------- DATE ------------------------------------------ ADDITIONALCOMMENTS -------------------------------------------------------------- ------------ ---------------- ----------------------------------------------- ----------------- --------- ---------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ----------------------------- --- ----------------------------------------------------------------------------------------------------------------------------------------------------------- -------- ------------------------------ ------------------------------------ - ------------------------------------------------------- --- ----- ----------- - - -------------------- Final Inspection by: - - - ------- ---- ------DateQ' SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M G \U