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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I pTriplicate) Permit No.7 :3 _/' r y a (Complete in This Permit Expires 1 Year From Date issued Date 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . 7 C/--` ° `n 5 °N-----� ----- -----------------CENSUS TRACT -------------- - -------- Owner's Name ._�-1��!-=--- Cy_�Y L ?--------------- --------------- -Phone _- - C3 Address 967----- I"' ----:- `-------------- City 14/ -----------------------------------------•-•-- License # Phone Contractor's Name -.../_� `^ - _� l/' --------- ----=- ------- Contractor's i Installation will.serve.'. Residence tRApartment House-E] Commercial❑Trailer Court l❑ - Motel ❑ Other -------------------------------------------- Number of living units:----i------- Number of bedrooms _________Garbage Grinder ------------ Lot Size --______________________--________________ Water Supply: Public System and name ---------------------------------•---------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand 9� 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 availa le within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Siz ------------------------------------------- ---- Liquid Depth --_-------------------- Capacity ----- -------------- Type --------------- ---- Material------ --------------- o. Compartments ------------•--------- Distance to nearest: Well --------------- --------------------Foundation --- ----------------- Prop. Line -----_---------------- LEACHING LINE [ ] No. of Lines ------------------------ Lengt of each line--------------------- ------ Total Length ----------- _---- 'D' Box ------------ Type Filter Materi --------------------Depth Filter Material --------------------------------------.•._._ Distance to nearest: Well ____-______ _________ Foundation _---_____ ------------ Property Line _____________._----_---- SEEPAGE PIT [ � Depth _---- Diameter ___ ____________ Number -- ----------- ------------- Rock Filled Yes ❑ No 0 Water Table Depth --------------------- ------------- -------Rock Size ------------------------------- Distance to nearest: WeIJ------------ ----------------------------Foundati n _________- Prop. Line ---•------•---•------- I REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- ----- -------------------- Date ----- ---------------_----------) Septic Tank (Specify Requirements) -------------- r?_— - ------ ----------- --------- -------------------------------------------------.----------------- ----------- _ - / ------- ----------- Disposal Field (Specify Requirements) 571V �- �-��`'' /��/-------- - --�-�--- F'�-------------- --- ' lll� ---------/ -a--------, 'l S f ------- A--------------------------------------------- ----- ------- ------------------------- --------------- - - - - (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: "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." Signed - - - - ----------- r ------------------------- Owner By ------- - i -- ---- ---------------------- Title ----------------------- ------------ ----------------------------------- (If other-than owner) FOR DEPA-RTMENT USE ONLY APPLICATION ACCEPTED BY ------------ G J - DATE `�� r ------------------------------- BUILDINGPERMIT ISSUED ----------------------------------------- ---------------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS--- --------------------------------------- ---------------------- ------------------------------------------ ----------- ------------------------- --------- -11------------- ----- ---- -------------------------------------------------------- ,` '----------------- ------------------------------------------------------------------------- ---- ---- - - ------ ------------- ------ --- --------------- ----- - - ------ --- Final InspecTaR-bac -- . �/, Da#e � a ! SAN JOAQUIN LOCAL HEALTH DISTRICT F_ H. 9 1-'68 Rev. 5M