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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------- (Complete in Triplicate) Permit No. -7 _7_1.o __ This Permit Expires if 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 com liance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ----------------------- ---- __ --CENSUS TRACT _______________----------- -- ------ --------------------------------------------------- Owner's Name _ Phone Address �1 �✓ City ,/'= ` r Contractor's Name ±t:4-4---- ------- --- -t 4----7� t f Phone --------------------- -----5------- ---License # -/�� --------- Installation will serve: Residence Apartment House❑:Commercial:❑Trailer Court ❑ Motel ❑ Other----- ----------- Number of living units:_.r7:777_ Number of bedrooms ___:.Garbage Grinder _.---------- Lot Size _______________________________________---. Water Supply: Public System and name ---------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt[IClay E], Peat ElSandy Loam py 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 ublic_sew?r_is available within_2d0_feet,)FF� PACKAGE TREATMENT [ ] SEPTIC TANK 5ize_ � Liquid Depth ___ ...... _ ` 9 tf Capacity !` -PCIA PJ Typ -~-_ Material_�`'*�+ - �____ No. Compartments ___ ""_._......_. 0I If v Distance to nearest: Wel! ------------------------------------eFoundation _ Pro Line ---____�.........- -LCA------------- p• LEACHING LINE [X No. of Lines _______ ----------- Length of each line--------- Total Length _____L_K�..........__ 'D' Box _—______ Type Filter Mateirid-1----- -------1.4----___.____ ' Distance to nearest: Well ----------&P:7,----f-fou6ation�,- ---------------Property Line _.___C............... � SEEPAGE PIT [l� Depth _` ,_a_f_______ Diameter _____ _�__,_ Number -----------------------`�_ Rock Filled Yes { No C]Water Table Depth ------------------ ----------------------Rock Size ---r x 3 --- J r ! Distance to nearest: Well __.___.-----_-- ---------------------F6undation ___],0______�:___ Prop. Line _...____._______.____. REPAIRJADDITION(Prev. Sanitation Permit# _______ ------------------------------------ Date --------------------------------- 4 SepticTank (Specify Requirements) -----------------------------------------------------=----------------------------------- -----------11--------------------------------------- Disposal Field (Specify Requirements) ---------------------------------------------" =-; ;- ---------------- - ---------------------- ---• ----------------------------------------------------------- ------------------------------------------------------------ ----------------------------------------- ---- --------------- ----------------- (Draw existing and required addition on reverse side) y 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: "1 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 ---------------------6 Owner ----------- J BY --------------- -------------- - -- ------- -- - ---- = Title ---------- ---------------------------------------------- -- --------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -- ------- -- _ -------------------_. DATE _%:577Z._73--------------- BUILDINGPERMIT ISSUED -------- ------------------------------------------ -------- --------------------------------------------DATE ------------------•------------------------ ADDITIONALCOMMENTS ---------------------------------------------------------- ---------------------------------- ---------------------- -------------- ---------------•----------- - -------------- -- ----------- -------. --------------•----------------------- ----- - Final Inspection b Date f~ ---� p Y ----- ------------ - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.