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FOR OFFICE USE: y APPLICATION FOR SANITATION PERMIT y ................ �� Ss, (Complete in Triplicate) Permit No. 7 This Permit Expires 1 Year From Date Issued Date Issued ..6.--2.3-Zj. 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 41Y0 /-. .C?...... ...............CENSUS TRACT Owner's Name .. .� .�o�• .. xrx l ....................Phone Sr.8, � -/ ............. -•---•-- Address J.9D._.5770... ---Af -1_,ht I' r1 ... Cit .�!fE 1. ......:............ Contractor's Name -------- ---------------------- ....................................License# ................ Phone ....................... Installation will serve: Residence❑Apartment House�mmercial{]Trailer Court Motel ❑Other-----i ......................... .......... Number of living units:....1------ Number of bedrooms :_....__....Garbage Grinder ............ lot Size ........... Water Supply: Public System and name ~ Private ❑ ............ ��- ....................._...............--....... Sand---.........?..........----........ Character of soil to a depth of 3 feet: Sand Silt Q Clay 0 Peat[I Sandy Loam Q Clay Loam Q Hardpan p Adobe❑ Fill Material ............ If yes,type............... ............ _a (Plot plan, showing size of lot, location of system [n'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 200 feet,) PACKAGE TREATMENT SEPT T Ca acs } D L . .. P 1. yPe�__._.. .... Mated?- -,- pold .............. No. Compartments ........ Distance to nearest: Well Foundation •........................ / y Prop. line............y .._... LEACHING LINE ] No. of lines _._.�� U I // .-------- Length of each line.1�--_....._re--7,47_ Total Length !C. ��.............. Box ....... .__. Type Filter Material ........:......•.....Depth Filter Material . ------ -- ----------•-- Foundation _.__..---------•--.-...- Property tine _............ ...._... SEEP PIT e th �� _--. Diamet®r f O� -_. _ - .----- Rock Filled Yes � No 0 P ------ `� ..,1a .._._ Number ........ �[f 7 a'r" ater Table Depth ----��------------------------------------Rock Size ..I �.. ��._._ ! .4 Distance to nearest: Well ..., ..............................Foundation ........ Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation Permit# .__......__................................. Date .....-......-..................... ) Septic Tank (Specify Requirements) ................................................................................ .. _.... Disposal Field (Specify Requirements) --------•----------------- =;......................... ...-'... ----------,-•------------------------------- -------------------------------.---------------------.................----------------- ................ ............................... (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 Laws, and Rules and Regulations of the San Joaquin Local Health,District. Horne owner or licen• sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In such manner as to become s sect jWorkman's Com sation laws of California." Signed - ; / - - -•- •---------------------- ------ Owner 4 By ---- Title _....c�lf.Q / (If other than owned FOR DEPA MENT USE ONLY APPLICATION ACCEPTED BY • -- ------------------ -------- ----------------- DATE ....��.__.. -_ Q_.._...-----_ BUILDING PERMIT ISSUED ------------------------ -----•----- ---- ----------•-•---- ..--•--.----......_.._DATE ADDITIONAL COMMENTS --- - /.......:.......... - ------ s�---..7------ ..__._.. . --- _: r Final Inspection by: . --- - -- • - ------------—- ---•-- ------- -------------- .... • . --.._..---..._....bate . r EH 13 2h 1-(ate lay. SAN J AQUIN LOCAL HEALTH DISTRICT 8/711 3M