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#, FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -7 (t ---~----------------------------------------------- (Complete in Triplicate) Permit No: _.!_/:_-( _-T•_l ---------- ------------------------------------------------- -----------------------------------------:--------------- This Permit Expires 1 Year From Date Issued Date Issued 77/_�Y-7-1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wo*rk,herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ... 1__�-. --- _ ____--- u ..---------------------C SUS TRACT -------------- ---_------- e Owner's Name ----- 7---- ---`----- = ---- ------ ------------------------------------------------Phone _ 9 --- �'� _ Address ___�..�_ _ Cit F Contractor's Name ._ _'"_ _ __ __-- .atx. .License # i��a5�_. /7_ Phone _4 _. -e Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court i❑ Motel ❑ Other .--___--_ `� Number of living units:_-. __ __ Nu mber of bedrooms __,�____-Garbage..Grinder. _Lot_Size33�_ 6`1717----------- Water Supply: Public System nd name '==----- = :-_ =:::.._::_ = =-------------------------------------------------------------Private f ' Character of soil to a depth of.,3 feet: Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam V Clay Loam ❑ Hardpan ❑ Adobe-❑ Fill Material ____________ If yes, type --------.-_____--_..___-__ 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) k NEW INSTALLATION:, (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] SS-ize �i___ �1 ---�_------------------- Liquid Depth ____yG ------------- 1Q k Capacity ___,:_ Typed/__ 1 �- Material. 4'p No. Compartments --- -____________ ___ s Distanc0to ,nearest: Well ------419 ____________________Foundation ._ ------------- Prop. Line ----4�_.._----------- - LEACHING LINE [ ] No. of Lines ______ Length of each line-_____�d4__ g a� t 1 Total Length :.---oZ------------------- 'D' Box _ __ Type Filter Material __F&CY---Depth Filter Material -_/V----_________________________vl� _____ v Distance to nearest: Well-----V------------- Foundation _46 Property Line __- ........ SEEPAGE PIT,'>[ ] DepthDiameter 3�_--r___- Number -___-..___-_________ Rock Filled Yes 0 No 0 '-Water Table Depth -----------------P-----------------------------Rock Size ----- ---------------- Distance to nearest: Well ------//0___/i_ _?_ _____,____Foundation -------------------- Prop. Line ______________________ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank {Specify Requirements) ---------------------------------------------------------------- ---------------- 1 Disposal Field {Specify Requirements) ---------- ----------------------- ---------------------------------------------------------- ----------------------------•----------- --------------------- ------------- ------- --------- . (Draw existing and required addition on reverse side) j 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. Rome owner or licen- • sed agents signature certifies the followings e. l "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 ------- -----�ner) ---------------.---=--------------------- -- Owner •By �l�' oo-V!! ------- ------ ------------------------- Title - --- ---------------- - - ---------------------------------------------- (If other than o FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY =------ --------------------------------------------------- DATE -< BUILDING PERMIT ISSUED ----- ------ ------------------------------------------------------- -- - -- - --- ----------------------DATE -------------------- -- - -- - ADDITIONALCOMMENTS --------------------- - -- - ------------------------ '-- ---•-------------------------------------------=------- -- =- - - - ---------------------- - -_- ----�- --- ------------ _ --- ----- Finai Inspection by: Z �/ - Date '/ L SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M