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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT o ...................... R Permit No. 7 {Complete in Triplicate) _. ------ ---• .............. -9-7� . This Permit Expires I Year From Date Issued Date Issued 3 ; 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: aw rf �� JwA Y. OB ADDRESS/LOCATION .--- .- !)!...W................. .... . CENSUS TRACT ......... ..... Owner's Name ...__.13_tP.. .. _. .. .►..•.......��_X.0_5........ 313.r��.>�f��!�:_�..7.�4�...Phone .................... ... � Address .-....... 0. .. '.._ �1�� ..�3.7r % �e!._.:_� f ............... City .._. j'/ ..E1.► .�`_........__......-. ......... • Contractor's Name . .. rr�'C%V ! (47✓�"�i •`� . ....... License # �..................... Phone ........ ' ..,1._ Installation will serve: Residence❑Apartment House Commercial ❑Troller Court 0 Mote! ❑Other_ '°G;f' NaM Number of living units--) Number of bedrooms Garbage Grinder ............ Lot Size .4f !Y--4........................ Water Supply: Public System and name ------------------------:....................................................................................Private Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam a Clay Loam ❑ Hardpan ❑ Adobe 0 Fill Material ----..--_- If yes,type............... ............ ; `I (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,) i PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size....y"X.s....`...`................... Liquid Depth ..... ............, 1 Capacity 010-4.' Type Material.... No. Compartments. ..... .......... .-•-. Distance to nearest: Well ---------------------------------...Foundation -----k�........... Prop. Line .. ._._:___.._.. LEACHING LINE [ ] No. of lines _..�--_._____-_____ Length of each line-------- -------- Total Length .......... D' Bax .... ...... Type Filter Material - ..Depth Filter Material _.A0 A �j Distance to nearest: Well ------------------------ Foundation -----------------------. Property Line ........................ SEEPAGE PIT [ ] Depth -- 1............: Diameter ..... Number --_----_-_--.-----..- --- Rock Filled Yes ❑ No (3:r Water Table Depth -------------____.........................Rock Size •.................I............. Distance to nearest: Well -- ........ ......'Foundation .................... Prop. Line ....... ............I REPAIR/ADDITION(Prev. SanitationFPermit ` _. .r_.7. is............. .•-- bate ._.l.-............... ... :) f I , Septic Tank (specify Requirements) I ...... VP. .......................................•-- ..... i „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 Joa uln County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:Dlstrict. Home owner or cen- 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 annex as to become subject to Workman's Compensation laws of California." Signed _._. .� �fd�!s �� Owner �... ------* --- BY ----------------------------------------- Title i W� ft!ntwner] FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ....... ---------------- -------------------------------•-•------------------------------. DATE _ ..�...7.�_...------ BUILDING PERMIT ISSUED --------------•---• -------......... --•-------••-•- ---- .. --. -- _._ ..,............DATE •--- ------I............ ,_... ADDITIONAL COMMENTS ----------• --••..................................:...........................................:_-------------•- .....-•------ ;,... ------------------ -- - --------------------------------------------------. ----------- --------------------- Final Inspection b Date _.��.. _________________ + ' --EH-1-3-2b-1-68 _itev. 5M- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M