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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .....•...... . ., .. (Complete in Triplicate) Permit No 7� �O-rte ......................................................... This Permit Expires 1 Year from DoM Issued.. Date Issued . ._... .._7,.. 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 .........R4�- s a- }. J ._.._.__. CENSUS TRACE Owner' 0 s .......................... Name ,r.-1•d-� V.1�.1..�.(_�h. . �7 • �' ......................•• ........Phone .. ... _ .-ti. Address '` � ........................::.... ..._._. city Contractor's Name �•Y 1-._ .........License 5 .�? 3 .Z....... .. Phone _. ._... ... 9.... 7 Installation will serve: Residence --• -• -------- rtment House] Commercial QTrailer Court >] Motel❑Other-- . ...................•--- Number of living units:_..... ..... Number of bedrooms --Z_--Garbage Grinder ..AV_ .. Lor Size ..... Water Supply: Public System and name ............................ -----.._...................._...................................................Private Character of soil to a de depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat❑ Sandy Loam fl Clay Loam Hardpan 0 Adobeill Materlal ............ If yes,type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pfaced on reverse s NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer 11 avails PACKAGE TREATMENT 0 feet,} ] SERV TANK r _-_--- -- �Urepth Capacity 4��a Type .. .. . . ........ Material.. No. � _..._..._..:,..._.. Compartments Distance to nearest: Well D `'- •-------•• --Foundatio ------ ............... n .._ Prop. Line ..:S.D............5. LEACHING LINE No. of Lines ..._._: _..-•-•_---.. Length of each line.._--• .---(_ Total Length , 7v - :. s g ...7.. ......�.._... ©' Box ... -'Type Filter Material ...... ............Depth Filter Material .....2•..,,,.,- Distance to nearest: Well ....... ........ Foundation ... SEEPAGE PIT Depth ----- 5;V �3'c Property Line .... --- Diameter ....... ....... Number Water Rock Filled Yea No C]Water Table Depth ..._._.: ............................... ...Rock Size Distance to nearest: Well ....:_...rte.-.................Foundation ..... REPAIR/ADDITIrop. line ................:..-.. QN(Prev.(PreuSanitation Permit ---------------------- ..................... Date .............. : --� Septic Tank (Specify Requirements) ....................... JWr� ... .... Disposal Field (Specify Requirements) � .. .. ---..... ...... .......... .......................... •_•........... .......••_-----------_..------.----...._....__._................•..............._.................._............_.:............................. (Draw existing and required addition on reverse side) ! hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local.Health, District. Homo 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 shalt not em to an as to bI*me scuubject to Wor man's Compensation laws of California." � p y y person in such manner Signed -• r h ._ ------a-.S.' 7/0----- Owner BY -- (If other than owner) ---- Title - ----- -----_1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- BUILDING .BUILDING PERMIT ISSUED --- -- -- -- -- ---- --- --------------- __-.. DATE ------------ ---- - ADDITIONAL COMMENTS ----------- --_---- - .-• ------------------- --DATE -- - ------•---------------- ----•-- -------••.............. . .... ..........................................................._.__._..__._.. .--_..._........__._......................... Final Inspection by: ..._. _. _ - ---------- --- -•-.... ............ ...... �. 111 13 2h 1-68 ----- -- - --•-.. ....................................................Date -. ... --��.-/...,�..�...._ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M