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FOR OFRC&US& T APPLICATION FOR SANITATION PERMIT a (complete in Triplicate) Permit No.- 7Z7.f ' Date Issued ... ............•----._.... This Permit Expires ] Year From Date Issued f 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 CENSUS TRACT Owner's Name ` hone ...•.• • Address ...... city.�. ...................•----.....--•-•-• w, Contractor's Name .:_... .:- lf. dC��'•••-• - Sam .............License Phone Installation will serve: Residence❑Apartment House 0 Commercial oTraller Court - Motel ❑Other _..f„1 v G . - Number of living units ..... _..-_ Number of.bedrooms ..__:______Garbage Grinder _._......... Lot Size ............� yC-?--------• _Water Supply: Pubiic'System and name ......:........ -----------------------------•--• ...... ................Private ®. Character of soil to a depth of 3 feet: Sand j] Silt 0 Clay 0' "Peat 0 Sandy Loam Clay Loam --• - _-Hardpan')_]-'"•"-Aciobe 0 FM Material ..__._.:_--. If es Y ,type __-------•---• I (Plot plan, showing size of lot, location of-.system' in re ation to wells, buildings, etc, must be placed,on reverse side.) NEW INSTALLATION: jNo septic tank or seeps pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] :it SEPTIC TANK f ] Size.....................-•-•.......•---•............ Liquid Depth _ ...... Capacity ..-/&'Ci.-[Ca4TYpe ��-C�sj' Material---- b�Gr._._. No. Compartments ........ Distance to nearest: Well .___.__. � Foundation ..._..t_e. ....____ Prop. Line .Kd � f LEACHING LINE [ ] Na. of Lines ......... ........... Length of each line---_._ �G13 �} Total Length . : 'D' Box Type'Filter Material /fid C, Depth Filter Material Ate'`` j .......-•-•--••.................. Distance to rsearest:...well ..._._.._` .. ` Favnaatian ` ` Q••--•-•-• _..1_� ..:.......... Property- Line :.. fid• . SEEPAGE PIT [ l � Depth`0...:--.�h.......... Diameter ............:. Number -----------. .. -------- Rock Filled -Yes, [:1-_•:•...N0-Q' [" t Water Table Depth h p ------••........................................Rock Size ................ -•....: .-• - ... . .. ..,•...,. ' Distance to nearest: Well ......Foundation ...... Prop.. Line REPAIR/ADDITION(Prov. Sanitation Permit ` ,-•-•• Date ~ Septic Tank {S e6 Requirements) --- ....:...........:........ . ......... Disposal Field-(Specifar_-Requirements) ............................................. - ; ----------------- �s prepared--(Draw a existing and re uired addition on reverses de) ....... • -- -- .............` 9 q I herebycertify that I have this application and that the work will bedonein 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 folio* ing: "I certify that in the performance of.'-the work for which this perrnitlis issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of Califarnia." �Signed . J . _ - - -Owner ......... - ------------- BY .��. .._..... . Title _ ( of er t " rj FORD RTMENTy4115E ONLY APPLICATION ACCEPTED BY__. . ._ _ _ 7N................................................ . DATE.v r`. =7......:.....•.. BUILDING PERMIT ISSUED ........................... . . --.....----DATE :.._....__:_:_...:....:__....___.__. . ADDITIONAL COMMENTS ......:.......•___..-• , ............._..._...- ........................ ---- ................................... .........._ .......................... Final Inspection b .,.. .......----- --- - --• •_.. .__ ............ P ,......• ..............: Dat - .. a -- ---- -- ------- ----------------- __;SAN JOAQUIN LOCAL HEALTH DISTRICT ---_E._H.13_24j-'.68._Rev..5M -71-.n .,