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ti FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT Permit No_.7 /.... (Complete to Triplicate) ` Date Issued j ......................... ._. _...._...__0l..._ This Permit Expires 4 Year from Date Issued Application is hereby mad to the San Joaquin Local Health' District-for a permit to construct and install the work herein described. This applicatiorilis invade in compliance with County Ordinance No. 549 and existing lea and Regulations: JOB ADDRESS/LO` TION:._.. 4- .. CE US TRACT .......................... Owner's Name .T .. .[s.Ed.! ..5.....1� d✓oi5/ �]/t N0.41 ........Phone .... ........................... Address .� � ®./ �itrT/ Z1E__. «�Tl ._� .1__.City . Cl .�G ---------------- Contradar's Name ---_ � 't._f''tf _-- cv _:_.._..Z...License # . /..�.,�. Phone Installation will serve: Residence XApartment House-0 Commercial❑Trailer Court Motel ❑Cttherr. .................... ...................... 9 9 � 5 ...... Number of living units:-.-- ...'_ Number of bedrooms ._t�.�`.�_Garba a Grinder .._..___.... Lot Size ... .............� - Water Supply: Public System" and name �•- _- � ._•........................_--_-...................................• Private Character of soil to a deptl,o' f 3 feet: Sand Silt.❑ Clay ❑ Peat 0 Sandy Loam 0 Clay Loam ❑ RS II I ' Hardpan ❑ Adobe 0 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 seepage pit .permitted If public sewer is available within_2Q0-feet;) PACKAGE TREATMENT [ ]I� SEPTIC TANK f ] `� Size..... 3C.IX---_----_-- -------- Liquid Depth ..... JP t1+ } _ YPMaterial.. - No. Compartments ....ski.... Ca aci _�i.�DQ_:__-- T e --� .. Di Lance to nearest: Well ----0Q(.? ..............Foundation --- ----------- Prop. Line .:........ LEACHING#tom [ ] No. of Lines -------------------- Length of ach line.......................{.___ Total Length ........... [=t ITC4?,—IFS y V:Box ••-.1:..... Type Filter Material /..�zx_.. `__...Depth .Filter Material ._._f�'.......... ........... ---------- Well _.� .--_...... Foundation --; .............. Property Line p....-_........ SEEPAGE PIT [ ) Deph --------------------to nearestDiameter -- ------------ Number -------------- -.---- Rock Filled Yes Q NoA � W ter :Table Depth .................. Rock Size i OA Distance to nearest: Well ......... .............................Foundation _... ..._ . ........ Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# _ ) � - Date � �-' Septic Tank #Specify Requirements) ._.:-_--. ------------ i p • : f i Disposal Field (Specify !Requirements) . .............. ----- M 1 III __ } � .... ------ -------------- f- �F ---- --. - ----- -•••---- ------------- -- ---•-• . .... (Draw existing'and required addition=on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State ,6ws, and Rules and Regulations of the San Joaquin Local 1•leatth:District. Horne owner or licen- sed agents signature certil`46 the following: w "I certify that in the perforhionce.of_the work_for-,which this.permit Is-issued,_l�shall_not_em ploy any person in such manner I as to becom ub)ect to Workman's Compensation laws of California." Signet( ,-+ems-... - Own r , ..._ ._. . -- J -ltd : BY ------^I'---- -- T itle -- = -- . . .--- (If other than o net! 4 FOR DEP*ARTME UjE NLY 4i- APPLICATION ACCEPTED BY:-•-.:.................•-------------------- ------ ----.. DATE .....1.7 -Z.7------------ --------- BUILDING PERMIT ISSUEDi0 - ............... ... V��._.._..DATE - ... ADDITIONAL COMMENTS 11 - ... --•-•------------- ' ---------------------------- ------ ------ • --------------•--------- ...................... ------------------------------- ----•_.......--------------. - --•--•- ----------------------------------'I._.:----•----------•-•-------...-•--- ------------------------------------------- j y- ._....._...----..._ -,.;f. 77 Final Inspection by: •------....1M----- -.--- -------------.._.... .._.. 1:!... . .-Date ...... .: -...._. ... EH 13 2h 1-68 Rev-' 5M SAN JOAQUIN LOCAL HEALTH RICT 6/7h 3M ' f'