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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -- Permit No, 7_Z...1_. !. A (Complete in Triplicate) ..........I --- Date Issued ................. This-P It Expires 1;Year From Date issues! Application is her made to the San Joaquin Local Health District for a permit to construct and install the work herein- w described, This application is made in compliance with County Ordinance No. 549 and existing Rules:and Regulations. JOB ADDRESS/LOCATION .._7_,?_I.--,�r--G- ---�- - . ------.CENSUS TRACT Owner's Name' ___... - / - • -----t ---:...----• - Phone . Address �,� - F.,GtY== -- ------ ................................... Contractor's.Name License# Phone - Installation will serve: Residence Apartment House❑ Commercial:❑Trailer Court Motel ❑Other __.................. ...... ......•-...._ ` Number,of living units:....;1------ Number of bedrooms .- ......Gqrboge Grinder .... Lot Size : " 9'--.. ---•-- Water Supply; Public System and name ,. .: -........................... . .__..._ ..................... ,._ Private Character of soil t*a depth of°3 feet: Sand 0� Silt Q dray-Q ` •iseat❑ S6ndy toam t ' Clcry loam Hardpan ❑ Adobe ❑ Fill Material ............If yes,type -------------------- (Plot _-a_ -- -- ---- ---(Plot plan, showing size of lot, location of system in;relation to wells, buildings, etc. must be plowd. on reverse side.) NEW INSTALLATION.- (No septic tank or seepage pit permitted if publk sewer is available within 200}feet,) Size--------- ------ -.:.PACKAGE TREATMENT SEPTIC TANK[ Liquid De tli Capacity Type ....... ate ....... MalGrial- - ---------- No. Compartments ................. Distance to nearest: Well . ......... .... ................Foundation ...................... Prop, Line ............. LEACHING LINE [ ] No. of Lines ...---- ----...--:- Length of each line------ -------- ------=--- Total Length ...._ .I-.. ........... . 'D' Box -------------- Type Filter Material --------- ..........Depth Filter Material. . ........ ....:..: .,.. ....... Distance to nearest: Well ...... ............. Foundation ........................ Property l ne .................._.... SEEPAGE PIT [ ] Depth _----------------- Diameter ............... Number --------------------- Rock Filled Yes ❑ No 0 Water Table Depth =----- --------- ----- ---- ------ --------Rock Size................................ Distance to nearest: Well ::.-- .. . ...... ........ .......Foundation .................... Prop. Line ..................... iREPAIR;/J iWTION(Prev. Sanitation Permit'# ------. •-- ----- -- -- --•---_-- Date ............. ..................) Septic Tank (Specify Requirements) -__--_ .................... -- --•- . .' tt 11 � •• Disposal Field (Specify Requirements? ---.__ - .�"� ( , / -------------------------------------------------- -------- ....---- -- ---- . ------ ....... -- • ...................... ................ -- , (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this appilcation and that the work will be done in accordance witk San :Joaquin County Ordinances; State Laws, and Rufes and Regukttlons of the San Joaquin Local Ne" District. Hens"owner or liven sed agents signatura certifies the fob. "I certify that in the,performance of the work,for which this pern+lf is issu", I shaft=not ensploy;: rq► per:M such manner as to become sublect to Workman's Compensation laws of California." Signed'_ ____ Owner BY � or ------- --------- ---•----- - -----•-- ------------ -----... (I€other than owner)' FORDEPAIITIyIENT LISE ONLY APPLICATION ACCEPTED BY_ e_14.' ------•. ................................................... . DATE. `'- '" ............. BUILDING PERMIT1SSUED. ............. .._ : ADDITIONAL COMMENTS ------ --- --- - .--- ---- ----• -.... --_..._ ..... ........ ------ . .. ------` •-- ... : --........,_. ............................. -- . ---- FinalInspection b ..+t,.el- t '-- ------------ -----------••• ...--_ --•- -- •----•. ...Date _._.5�.. .:_ ....... ._.._.. .: SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68Rev 5M n