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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.�7-� (Com ete in Triplicate r _.._t_. _...__...� ___.._ _ ---------... ----------------- .............. _, Date Issued 7 "s*` : This Persnit Expires t Year From Date Issued Application is hereby made to:t San .Joaquin Local Health District for a permit to construct and install the work herein desccib�d its iication de ' compf' c Cou �Ordirae_� 49 and existing Rules and Regulations: r JOB A DRESS LOC ... ...... ......................!-.:......._' CENSUS TRACT Owner's Name ...p ?.✓�K - �h�✓�9 ✓CoGG� Phone .,��.?.rn 7/b t Address ---------eT, ...... City ................................................. Contractor's Name ---67Z 1Z' _...License # .-/&0.......... Phone .. .••••-•........ Installation will serve: Residence ?rApartment House❑ Commercial❑Trailer Court ] Motel ❑Other ............................•--• ........... Number of living units:..-../-.-. Number of bedrooms 3 Garbage Grinder lot Size ....�'�Z .�X..• ......• Water Supply: Public System and name ........................................................._....................................................Private is Character of soil to a depth of 3 feet: Sand❑ Silt.❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam = . Hardpan 0 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 ( 3 SEPTIC T NK� Siae.. -1 Liquid Depth ..� 2�.............. Capacity, ._60_--__ Type6r6e<4fMaterial. TiJ. f...._ No. Compartments ...... .......... Distance to nearest: Well ------- ....... ...... Foundation .__ ............. Prop. Line .......1?0......... LEACHING LINE No. of Lines . ��. ............... Length of each line J._�...�.Q...........-- Total Length �.----....-• 'D' Box ..�- Type Filter Materia f. .....�� ep `F'Iter Material .-a��................................-•-- pistance to nearest: Well ..1.�-c�....ffoundation �_U.-�__...._..... Property Line..�t�-� •�'�G��/� S �{�� Depth .................... Diameter .....----------- .Number ----------------........---: R�isfk".filled"Yes ❑ 1 No ❑_ . ` = s l .X I Y Water Table Depth ••---------------------------- -*------------- Rock Size �........ } ti' i Distance to nearest: Well .. ...................................Foundation ......._..I.-----...�Piop. Line .....: ............... REPAIR/ADDITION{Prey. Sanitation Permit# ........--- ----------------------•--I------- Date ...... ..--:------------T... :.. ) Septic Tank (Specify Requirements) :...._..-•-------------------------------------------------------- s... ::..._,..._........__.......__...._. Disposal Field (Specify Requirements) ------------••--• ......`------•--...,..---•----- -----------__.............................. * • ------....__... .............. ------•------------------ -----------------------------------•--•----------.._.±...------------.------------------------------., ......... _...... '. -------------- . . , - ........................ (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 wilh San Aoaquln 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 becom subject to Work n's pensation laws of California." Signed ��fy----------• -• -_ Owner 5 r By __--------- ----------------------------------------------=---------•-------------------------------. Title _------------- ----' ----..`..-------- ...._....." ------- .......... (if other than owner) FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY __- -- DATE BUILDING PERMIT ISSUED_- ...----_ --• DATE - w� ADDITIONAL COMMENTS Q-Ge�_ --fir. -------------- ` � w ---------- -------- --------------- -------• --------------- ------ --- ................. --------_. •-- -- - -- - - :'= =- Final Inspection by: --------- ---- - -.:_.._ ...__._.. . -` a" w.c5__...pate ....�-�.,/�. X7,7 v } _...._ ..�:.. EI 13 2h 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT �� ,a' 874 3M'