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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT A 'Permit No. � G 7 -- --- - ---- (Complete in Triplicate) ------ /W-1--------------------------- -- ----- ---- � , Date-Issued ---------------------------- -_-_-- This Permit Expires 1 Year From 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: -1 17JOB ADDRESS/LOCATIO 4/__ �-°---XjWe �"� f - CENSUS TRACT ... -- Owner's Name, '44 te.��---_ o_,Ov._��ad-------------------------------------------------------------PhonedF-w--.'-�O�f---- ,g� ---------------------------- Address _ � �_ �� / �'10 � Citys � E Contractor's Name _ _x__AAP411- ----------------------------------------------------License 40_ PhonO;f � =VP-------- Installation will'serve: Residence PrAApartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -------------------------------- --- Number of living units:---I------ Number of bedrooms -!---_-Garbage Grinder _'- ----- Lot Size .......... Water Supply: Public System and name -------------------------------------------------------------------------------- ----------------------- Private [ Character of ysoiI to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam � 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.) r NEW INSTALLATION: (No septic tank or seepage pit permitted i� u`i sew is avails le within 200 feetor At ,) PACKAGE TREATMENT [ ] SEPTIC TANK [� Size1-_q__.._!r..C_.2 _- __----___IA? Liquid Depth .7" .............. Capacity l�CoQ__ Typt � Material-_ .____ No. Compartments `` ___ ........ s Distance to nearest: Well tJ �- ------_............Foundation _io �___---_._ Prop. Linelt0------- lop LEACHING LINE` [ No. of Lines __J-_______.,______ Length of each line___ p__------,--<--- Total/Length --------------- 'D' Boxy ___ Type Filter Material ff®re--___Depth Filter1vlateriai !----_f-................... ........... Distance to nearest: Well _ Q_ _-___---- Foundation ------------- Froperty Line 14940-------------- SEEPAGE PIT 4 ) Depth --------- ---------- Diameter ---------------- Number _______ ________ ______ Rock Filled Yes '❑ No 0 WaterTable Depth ------------------------------------------------Rock Size ------------------------------ Distance to nearest: Well _____.._____.........................Foundation -------------------- Prop. Line -----------_-------- REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------- Date -------------------------------_11 Septic Tank (Specify Requirements) __:----------------- ----------------------------------------------: ----------------------------------------------------- ------------- Disposal Field (Specify Requirements) ---- --- ---------------- --- ----- -------- ----------------- - -- ------ --- -------------------------- -- ------- ----- ---- ---- ----- - i - ------- ----- ---• -- ---- ------------------------------ -------------------------------------------------------------- (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 Sart Joaquin Local Health District. Home owner or )icen- sed agents signature certRfies 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 subject to Workman's Compensation laws of California." Signed Owner _ r C +.`'z - Title L-GL� _. � / (If of er than owner) p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----TtS---------------------------- -----. DATE ------'--24-7;-- ------------------- BUILDINGPERMIT ISSUED -------------- -------------------------------------------------------------------------- ----------------DATE -------------•----------------------------- ADDITIONAL COMMENTS -------- ---------------------------------- ------- ------------------ ------ ---------------------------------------------------- Final Insp -------------------------------- Date ---- -- --- _ . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M