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X -- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------ Permit No. 7 -c3S1 (Complete in Triplicate) ---------- ------ -------------------------------------------------------- `k Date Issued _ -73 This Permit Expires 1 Year From Dnte 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 mad',e in compliance with County Ordinance No 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _ ' L __- �L�IZSQ Y__ -----S -C -------------CENSUS TRACT -----------------_------ Owner's Name _A_Q i9/-5------- 1 S d ------------------------------- --------------------------------------Phone 93 `Q,30-- Address --- ---J._�. f/ViZ---- ----- i#y _ VWL. _ _ U -------------------------------------------------- Contractor's Name -- _�/�___..-,+coq__ezy_4�____________________--------License _yf_S!______ Phone Installation will serve: Residence 5rApartment House�❑ Commercial ❑Trailer Court i❑ i Motel ❑Other -------------------------------------------- Number of living units:------ _._ Number of bedrooms _•z_____Garbage Grinder ------------ Lot Size _ ___:_____-__ s Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private ❑ -Character-of soil to a depth of 3.fee Sand'❑ Silt-0,- gClay,�❑- -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.) NEW INSTALLATION- (No septicitank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK'[ ] /thea ize----- ------------------------- ---------- --- Liquid Depth --------------------------- Capacity #------------------ Type ------------ aterial----------- --------- No. Compartments --------- -------- Distance to nearest: Well _ _________ ________________Foun tion ---------------------- Prop. Line ____-.-_-- _---_____ LEACHING LINE [.] . No. of Liries _________ _____________ th f each line_____ ______________________ Total Length 'D' Box---j---------Type Filter. ria v--------------------D pth Filter Material -----------------------------------------_-- w " -Distance to nearest: Well ___ _ __________ Founda on Property LineSEEPAGE PIT [ l Depth ____________________ DiametNum e� _______________._________ Rack Filled Yes ❑ No i❑Water Table Depth ------------- ------ -------------- -----Rock Size ------------------------•------- Distance to nearest: Well _____ ___________________ _______Foundation --__._________-__ Prop. Line ____-__-__---_-_-_- REPAIR/ADDITION(Prev. Sanitation Permit# ------------ ----------------------- Date ---------------------------------- Septic ----------------------_----------Se tic Tank (Specify Re uireme h1 DisposalField (Specify Requirements) ---------------------------------------------------------------------------------------------------------------------I--------------- 40 v - _- _ _ -`----------- ---_---- { (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 San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: k "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner I as to become subject to Workman's Compensation laws of California." i Signed ___ : _ _ Owner ------- -- ----------- ------ ----------- ----------------------- By ----= _ _ ------------- ---- Title ---------------- --------- ------ --------------------------- other than owner) a F- FOR ,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '----------------------- v G 1 1 DATE -:L '_2 3---------------- BUILDING PERMIT ISSUED'----:.----_1-------------------- - DATE -------------------------------- ---------- ADDITIONAL COMMENTS ----- ---------------------- ----------- ----- ------------------------------ ----------------------- --------------- .t ;t =------------ --------------------- ---- -------- - ------ ----------------------------------------------------------------------------------------------------- ----------------- k f -------------------------------------------------------`--'--------------------------------------------------'----•-------- --- --; - _ ------- -- -- ----- Final Inspection by: --=- - ------------------------------------------------------------------------- Date ----- 7- 3---- -------- SAN JOAQUIN LOCAL HEALT STRICT E. H. 9 1-'6l3 Rev. 5M