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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT s- ................................................... Permit No. 7 (Complete In Triplicate) . ..--.- This Permit Expires 1 Year From Date Issued Date Issued ._._..--•---........ 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 Mules and Regulations- JOB ADDRESS/LOCATION .... _�_ . CENSUS TRACT Regulations- :r_._.... . Y !► � ..... / .Q.................. ...................... Owner's Name .. c-L Phone ................ _ �-� / f• fllx�.a��._ , .. a-ic�1.- ................................. .............. .. ........... Address .��D..S ...S../I'[ . i.2t.L .. e'u. ..................... CIt _,!f��l .................. :._.._...................... Contractor's Name. .............. ---------• ......................-_.License # ......................... Phone ........... Installation will serve: Residence[]Apartment House-Commercial QTraller Court C] Motel ❑Other ...................................... Number of living units:----1_...._ Number of bedrooms ..Garbage Grinder ............ Lot Size .................... Water Supply: Public System and name :.._.�� _........_.__._._.............— ............. 1 - Private ❑ Character of soil to a depth of 3 feet: Sand Silt Q Clay gA Peat❑ Sandy Loam Q Clay Loath Q Hardpan[] Adabe 0 Fill Material ............If yes,type............... ............ (Plot plan, showing size of lot, location of systemw-in'relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage �lt permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ SEPT T ze ...... V.p" . .. ` . Uv ff � f •---. id De r �!.f Capacl l yse/____••-- !/. Mated I--- ------- ---------- No. Compartments ....... ........ Distance to nearest: Well .........:...............•....._..__Foundgtion ..........._.____..__ Prop. Line- ...... // rte•--•-- LEACHING LINE No. of Lines _._��....._..__- Length of each line"1�1�__�.__7,5Total Length !.`.� ..:........... 'D' Box ------------ Type Filter Material ....................Depth Filter`Material ............................................ !� �...�:....�Foundation ........................ Property Line ..................... . SEEP PIT {� Depth __4YaZ ..__._... Diameter'T---- 1?� Number ......................`r Rock Filled Yes ®-- No � � 1 r� �I ater Table Depth ? -----------------_--------_-.-..Rock Size .. i __.._70. .Foundation K� Distance to nearest: Well ...�$.............•----------..... -------•--........__ Prop. Line ...•--................ REPAIR/ADDITION(Prev. Sanitation Permit# .......-.----------------------------------- Date ----• ....................... Septic Tank (Specify Requirements) --•---•-•-----•---- ............---.--------.....................-............. ............................................................ Disposal Field ISpecify Requirements) •" --------------- - -----------•----------•----------------------------•- '--------------------••--------._....._......•--.._......._..---..__..........---.-•-•--------..._....................... (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 Son Joaquin Local Health:District. Home owner or Ilcen. 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 become s lett Workman's Comp sation laws of California." ^ Signed . - Owner _1.. - ---- - ._ --- - By ----- ------•------------------•-••-----•-•--------------------•------------•----• ---------- ------ Title _....... .t.1.l (If other than owner) FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY --- - - ------- ----------- - 1--•-------------------- DATE - ----------- BUILDING PERMIT ISSUED --------------• -----------•----_-- -- .--- ----------------------------------------- --------------- ........---------ADDITIONAL COMMENTS ---IS- /74 ----------------------------- ---------- ----- r-_. _ ---- f ._.._._- .._._ Q./.. (�. ��._ _ _ _ .C_ ...��___._..-_._. l -- -¢------ �fes._ _i�-r�- -G�----�(-.---CJ; -- -- FinalInspection by: -------------•- - -.. -- ---------...----- �-•----•-------...._.-�- -- -----� �-- -...-----..._._.._........__Date - �-- -. f�/O EH J-3 24 1-68 itev. f . _.._.._..... .......... 51 SAN J AQUIN LOCA€. HEALTH DISTRICT 8/7h 3M