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f FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,/ ......................................... .....• Permit No. ; 7 (Cemplete•in Triplicate) .........--•--• • ' 1 1This Permit Expires I Year From Data Issued Date Issued Application is hereby made to the San .Joaquin Local Health District for a per'mit to construct and install the work herein described. This application is matte in compliance with County Ordinance No. 549 and existing Rules and Regulations: 6�� Q�e.,��. . c JOB ADDRESS/LOCATION ,1.._ ...... :................. ._._....... -..mac?-✓-- ...............CENSUS TRACT' ........._..--- I Owner's Name -�.J _<...... ..... ....... ......... ................................ Address ............ ..•- '......_._.. ----_... .......... Ety ...........-_..........--•-•-.--•-•...---................................... Contractor's Nome --- .. . .,�a... e, ��°�' �! ---- License #9L��d� Phone ... ��..... Installation will serve: Residence tBrAportment House❑ Commercial ❑Trailer Court Motel ❑Other ... ........................................ / Number of living units.-.../ ------- Number of bedrooms _\9-----Garba_ge Grinder -._.:___._ Lot Size ...............: Water Supply: Public System-and name -______ Private E Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat C]_ Sandy Loam 0_ Clay Loam ❑ 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 seepa a pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[' Size_............................................. Liquid Depth .......................... 12 Capacity .-OZ010...... Typ .40_��... Materiai_ n. No.' Compartments .. -...............r Distance to nearest: Well _.__ ................Foundation ........ Prop. Line _94R ........ ...-.J �NLEACHING LINT: [ o. of Lines _..��.............. Length of each line-___ $ otal Length D' Ba ....__-- Type Filter Material?/ -Depth Filter Material .......If0�............................� :2:7_4 f Distance to nearest: Well _ f........... Foundation ... '? ........ Property Litre ..•.... SEEPAGE PIT Depth _..._......_. Diameter ....... Number ....... ............:..... Rock Filled Yes E No ❑ Water Table DepthP ,........Rork Size Distance to nearest: Well _102 ................ .........Foundation ...--- ............. Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ..........:.......•----,---- Date -•................................I Septic Tank (Specify Requirements) •••............ t Disposal field (Specify Requirements) ------------------------- -........................................................................................................ i _ --------- .............. _ % _ - • --...... --•x ---------- ---------------••----- --•-•-••....__....: - ..... . (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 that in the performance of the work For which this permit is issued, I shall not employ any person in such manner as to beco a sCecl_.F. to Work n's Compensation laws`of California.'= 'i'.: Signed , (7 -- ----------------------f•..Owner By --------------•-•--......_..._....._.._.. ='------ --.__.. Title::.._.....,_...... :....................------------------ (If other than owner) - FOR DEPARTMENT USE ONLY 1" APPLICATION ACCEPTED BY ©ATE �.. ^� •••. :......... ............ r 1 ... BUILDING PERMIT-ISSUED" .........................�._ ------- -...:-.._..._.............................. --DATE _.:��_.._ ' ADDITIONAL COMMENTS ........ ,iafe �'r 7_._. r` ... :_. .. .. _�r -.v...................:......... --••------._._......----------------------•---......--•---------•------•----•------ ------- ------------------- ------------ ................ .............................................. ---- ...................... Final Inspection by. •. --- ........Date ..rU...�� r ... SAN JOAQUIN LOCAL HEALTH DISTRICT E_ H_13 241-'68 Rev. SM _ _ 7/72 3 M