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FOR OFFICE USE: r APPLICATION FOR SANITATION PERMIT _... ../. -f....................`... Permit No. 7 ------1,9 -7 (Complete in Triplicate) .................................... ; .................. This Permit Expires 1 Year From Date Issued Date Issued / . ....... Application is hereby made to the San Joaquin local Health Districtifor a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations. . j nn JOB ADDRESS/LOCATION ... ..........LSP...... % -V � , Sv"� ------ �= =.:.+=....CENSUS TRACT __...................... .. Owner's Name �4 � ' �{•1� 7S _y6r __ ._ ..,. :_.....�...........�... d Phone ...__.. .• Address .... :'`/.. a�.._. 14.E] .4-e' _.'-------------- ------ -•--: city _.. .�d .+��_.__.� �_ ....................... +4 �.S+aE._.. _. �:--�-�-------.License #er ...� . �3 Contractor's Name --.-•_-. . .-.f.�'.. -- • - -• -•- _-- ''- --3.-._-_----- Phone Installation will serve: Residence (Apartment House C❑ Commercial ❑Trailer Court ❑ I i Motel ❑Other ------ ...................... ------•---•-•- - Number of living units:...../---_ Number of bedrooms _..Garbage Grinder ._._..._ --- Lot Size � Water Supply: Public System and name .......... :.__- ?-?'' ----------- ............ ------------ Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat[] Sandy Loom (-] Clay Loam ❑ Hardpan p 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public,sewer is available within 200 feet,} PACKAGE TREATMENT [ SEPTIC TANK[ j Size r..._. :_..--•............ .........:....... quid Depth ..___.__................-.� Capacity .....-----'..._..._ Type _:.............. Material........ Na. Compartments ......................j./ Distance to nearest: Well .. ..__-_.-...._.._.................Foundotion ..... ....._. .-...... Prop. Line --- LEACHING LINE [ No. of Lines . ... ........_ 'Length of each line...................... Total Length ........................... 'Dl, Box Type Filter Material ....... ...................... Distance to nearest: Well _.._.._._.............. Foundation ----------.............. Property Line ............ SEEPAGE PIT Depth __...... .......... Diameter __ Number Rock Filled Yes ❑ No Water Table Depth f......: •------------------------Rock Size ---_-----•-•--------•------- I Distance to nearest: Well__,.....................................Foundation _.__.._.. ......... Prop. line ...................... F V7 REPAIR/ADDITION(Prev. Sanitotiori Permit# .-.. _......:. .__.___.._.. .... Date ------------ t_____________-------------- �_______fi_._ _•------ Septic -____Se tic Tank (Specify Requirements) .........(....................•---..._..-•------•-- Disposal Field (Specify Requirements) .. X.................... .._. ' ................ ------------------- - ......... .--... -.. -------------------- ---- I i {Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin r County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or iicen- sed agents signature certifies the following: E "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 subject to Workman's Compensation laws of California." Signed w.. .... . ......... .. . .... - ------ ••-�----•-------- BY -- ..--- title _r. .... (if other than owner) I R ENT USE ONLY IAPPLICATION ACCEPTED BY ....... r' .-. .. ......... -----. DATE ....�� G.'.......5..__: ADDITIONAL COMMENTS ..: .. ::_-- -- ----- - - -------..�...._.... ------- DATE _.:..-...-- BUILDING PERMIT ISSUED -: - ----- Q/ O..H. ....... yj- ,�. .. °. !1.� —t^..?4.....0 .. l / . ........... ......... .-�--- _...._...._.�.......................... ......_ ....--- . -------- .. _ Final Inspection by -- ....... -----•-------.._Dat � '�-�• ........... SAN .IOAQUIN LOCAL HEALTH DISTRICT E. H. 1.3 241-'68 Rev. 5M 7/72 3 �K