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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7-1 !� --------------------------- -- - (Complete in Triplicate) Permit No. 1.7 ------- --------- -- ------------------ ---------------_________________ This Permit Expires 1 Year From Date Issued Date Issued __I_Z-_,W�:.7 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: s JOB ADDRESS/LOCATION TRACT�,Z,--- Owner's Name- --�----- --------------------------------- --------------- --- -------------------Phone Addressd — �{-- ---------------- City Contractor's Name -----�- --- -- - ----- - ---------------License # _ '7__ Phone ��-GK Installation will serve- ResidenceApartment House❑ Commercial ❑Trailer Court Motel ❑Other ---------------------------•--•------ .... Number of living units: --- Number of/b�edrooms -- --- Grinder �-� f --- Lot Size '. ' r�i Water Supply: Public System and name ----%_--_ -.- --------------------------------------------------Private [� Character of soil to a depth of 3 feet: Sand "Silt❑ Clay ❑ 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 septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK _____________ Liquid Depth --------------- O Capacity&C_C141-Type �^ Material___ 1- No. Compartments _____ _--_____-- Q Distance to nearest: Well ___t�---------_-------_---Foundation `______ Prop. Line LEACHING LINE `,p4 ' No, of Lines �______________ Length of each line----?.�l-_--___-_ --- Total Length ---o4_R- -------- r� Box ---�.__.__ Type Filter Material 1C nn -----_Depth Filter Materia! ___/1;17_ _______________________________ �pistance to nearest: Well ___ ............ Foundation ----lQ__r_-_______ Property Line SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- NumberRock Filled Yes ❑ No 0---------------------------- Water Table Depth -- ---------------------------------Rock Size ------------------------•---•--- "Distance to nearest: Well ----------------------------------------Foundation --------------- ---- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ...In, ________________________I---------- Date ---------------------------------- F Septic Tank (Specify Requirements) --------C��f�L�{-�--------��--------��U�---------------------------?•-----_- ------------------- Disposal Field (Specify Requirements) ___qQ_ L �__.____4PLA/------/ __ t4 f jam__' ------------------ 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 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 become subject to Workman's Compensation laws of California." ----------- t Signed --------- -------------------------------- - --.-Owner ----- ---- -- � ----- Title'`Y ---- ----- - -- --- ----- ----------------- BY --------------- - { --other� �_-------t'�'-- � ------ --------- 1 - --- - --------------- owner) ' +�— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __.-___i___Fl---q--------------------------- ------------------------------- ----------------- DATE ----- -------- BUILDING PERMIT ISSUED -- -- -------------- DATE --- ------.--- __. DITIONA COMMENTS _ , � nl ? Qr �---------- /11-------- -- -------�-_4M.J� ------------- ------------ -- - CC ! -4FT �_-� =---------------------------------- D � i _b! {-T_� r - LIr ��------- ---------------------------------------------------- -------------------------------------- -------------------------- - ---------- ---- - - ------------------------------------------------------- --------- - --- Final spection by; --�-------------------------Date SAN JOA UIN LOCAL HEALTH DISTRICT E. H. 9 5 1-�*S Rev. 5M :.