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FOR OFFICE USE: - , APPLICATION FOR SANITATION PERMIT ...............................................: Permit No. 7.7 (Complete In Triplicate) .. .---... This Permit Expires 1 Year From-Date Issued Date Application is hereby made to the San Joaquin Local Health District for a permit to construct-and Install the work herein described. This application,.ls. ee in compliance with County Ordinance No. 549 and existing Rules and Regulations. JOB ADDRESS/LOCAT ON7r___ � -- - r ........CENSUS TRACT .......................... Owner's Name _. G .. __.._._-ez .......... ._._. .....:: ------...Phone ........................... Address ..._._.._ ..... .: ...j ._..C Y ' ity . ._... .. ..... ..............................................---- Contractor's Name _.._ .. :.. '.... _ '....License + � � �?s . _.:Phone ----- ---------- ------------- Installation --- Installati n ' �--• - , o will serve.. Residence[]Apartme House 0 Commerciaall [ Tra ler Court j Motel ❑Other Number of living units_____________ Number of bedrooms _Garbage Grinder '' - ---•_....... Lot Size ��_..�..�_�.�.`........... Water Supply: Public System and name ......._..-.•.-- _ .. ...-...........................................Private Q. Character of soil to a depth of 3 feet: Sand❑ Silt❑ Cia ❑ Peat❑ Sandy Loom 0 Clay Loam❑ Hardpan❑ Adobe Fill Moterlal ............ 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 se pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEP C TANK eep gSize_-J...1�`.,f _../1 . sir f�... Liquid Depth .-'V_� a -- •�"Capacity i Type _ i`t c e.a?a, Material..__ 1x �,... -No. Compartments .. ............ M Distance to nearest: Well -. ,a - � ....Foundation ------1..p. prop. Eine ..-�---• LEACHING LINE _dal No. of Lines ___....a'-?........... Length of each line....... a..f�---___ Total Length .... ...... ' 'D' Box ....L._ Type Filter Material .....7D ... Depth Filter Material .... Distance to nearest: Well ..._._____. - � _ , .: Foundation......Pt?.�._.. Property 1.166 .... _:� •------••__-• SEEPAGE PIT ( Depth ---- Diameter Number ......-.o2.............. Rock Filled Yes No ❑ Water Table Depth ----•---------•-- ................Rock Size --.....- Distance to nearest: Well ...._''' ...u"-� :..............foundation --- ?.. ,. Prop. Line..--- ----- D REPAIR/ADDITION(Prey. Sanitation Pe 't# ............................................ Date—.........__:------• --........_..-} 1 o tic ank {S eel. airs en lrLLL!N! n...,e l/3,.Rv i .. .. ..............t,:rt'�------- UU _ Dis al field j ecify ec ireIts) ___' ---_ ,tf? � 1------- n ---..'v-1 5--- ...... J c,/ ------------- _ ___._ ..4 .... „f (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be Jane lit accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Hence 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 &half not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------------------- ------•----------- -- _- Owner BY .................. -�----- Title4'�-..-.-- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ---- ----- ---••-•------------------------- • --. DATE :._:.._ .-lA.._��.---•-------...-: BUILDING PERMIT ISSUED .. ----DATE .... ADDI ZONAL MME. TSS .1_!z_S.I��Cdrri 0 ----•- �� 1P✓ ..._S.. -.5. .... ----- �'�� c. �+z-.ce- #.-�-! �r1' E�1 ... e �....! P71 ._ , -.... _�.Z5.__.....�.lJ-Y_�k"li°.1C`_:.. 111.( -�• -�-- -----•------------ --------- ------------------- --------_- --------- ...... _�/__.. Final inspection by: .._/�Y.__ .. •--•-• • [3ate .�.� EH 13 2!t 1--68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT �' I 12-3 x,bd X5(+ f� 7 a 3 = 1799Z yw� 4/3Z, �d 3 17Zk