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r, FOR OFFICE USE: /APPLICATt*I�SANITATION PERMIT ------------------------------- �-7-- Permit No. _ 7_ ---tv6mplete in Triplicate) This Permit Expires t 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 Rules and Regulations: /7 7 - <:7 S-57 _ 23�'..`S��alJOB ADDRESS/LOCATION ------ --------------- __�--_ -9•---- Owner's Name ------ ED 6L ------------------------ Phone �City —Address ------ --------------------- Contractor's _ . Name-----Q- `----------------------------------------------------------.License #------------------------ Phone ------------------------_--- Installation will serve: Residence 2-4partment House❑ Commercial ❑Trailer Court ❑ Motel ❑ Other --------------------------------------------- Number ------------------------------------------Number of living units:_________ Number of bedrooms --- 6 ---- Garbage Grindery� _ Lot Size Water Supply: Public System and name-------------------------------------------------------------------_------------------------------------------Private [� Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay ❑ Peat Sandy Loam lay Loam ❑ Hardpan ❑ Adobe ❑ Fill Material _llff ---_ 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 200 feet,) J PACKAGE TREATMENT [] SEPTIC TANK,[ ] Size ------------------------------------------------ Liquid Depth ____________.._-..-._.__._ � Capacity ------------------- Type -------------------- Material---------- ----------- No. Compartments ---------------------- W Distance to nearest:_ Well ------------------------------------Foundation ---------------------- Prop. Line ...................... vl LEACHING LINE [ ] No. of Lines ------------------------ Length of each line ---------------------------- Total Length ........................ 'D' Box ------------ Type Filter Material ___________________Depth Filter Material ____________..-_____,_-_-------_.__-.-_.--- Distance to nearest: Well _______________________ Foundation ------------------------ Property Line ------------------------ j SEEPAGE PIT [ ] Depth -------------------- __ Rock Filled Yes D Diameter ---------------- Number -------------------------- ❑ No � Water Table Depth --------------- -------------------------------- Rock Size ----------••-------------------- Distance to nearest: Well________________________________________Foundation _____________-_.._.. Prop. Line ...................... REPAIR/ADDITION (Prev. Sanitation Permit # -------------------------------------------- Date __._____-_-___._____--__•.--______) Septic Tank (Specify Requirements) __� .X51-- ___` IZ ____© _____r&$-r�d�___-3__..B9PX M_..5__S7rF#1f Disposal Field (Specify ....... 6E ----------------- ----------- _DRa,PA�� Ila Vic.- �4Dp ��-10 W �J Ct�s"[rn� - TAN K = aNN�c-r i L>c�------ M---I� TflQ6 `T7_614T-_LI-&�- /&5TALL-- = 2 - #-�L1_NE --'i- T` (Draw existing and required addition on reverse sid_ 1 hereby certify that 1 have prepared this application and that the work will be done in accordance- in 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 be a subject to or an's Com nsatio ws of California." Signed ---------------------- ---� O ner By------------------------------------------------------------ °fit -Ck. Title ------ -------------------------- ----------------------------------- (If other than owner). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,__ ____ _______ _ DATE _____3_�_.U"..�__ BUILDING PERMIT ISSUED -------------------------- FO___AL- L ` ---------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS-------------------------------------------------------------------------------------------------------------------------------- --------------------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- ------ ------=------- Final Inspection by --'--- Date - �- �2--------------- -SAN ----• -- -SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M