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FOR OFFICE USE: / r APPLICATION FOR SANITATION PE'-SIT *a/ Permit No. 7_- L 77:7 (Complete in Triplicate) Date Issued This_Permit Expires 1 Year From 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: LJOB ADDRESS/LOCATION .��6y'-----�r� a r4d'-- ----- ----------- - CENSUS T -------------------- Phone ----------- -- ... Owner's Name t�� tS` - -- - Phone "rs -'. f ?� _- ----------I�C '-Q'----------- L Address -----------------------� •-� 0- J� 74------------ City ---------------- --------------- t Contractor's Name ----------- - _d� t�-�-......%�,-,r-Z------------...License # -C�-� --- Phone Y: L Installation will serve: Residence �partment House❑ Commercial ❑Trailer Court Motel ❑Other - --- -- ------------------------------- Number of living units:-----I._. Number of bedrooms _.d--22---_Garbage Grinder ------------ Lot Size ..-- ems- _? -.-------- LWater Supply: Public System and name -------------------------------------------------- '_........-------------------- -------------------Private ' Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe)( Fill Material ------ ---- If yes,type ---------------------------- 6�1 sr (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) D NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 6, PACKAGE TREATMENT [ ] SEPTIC TANK Size-.---.---X ................ Liquid Depth <_ ..._..,..._. -- Capacity`_ / �--- Type -Q------ ------- MaterialNo. Compartments .___..___.....:.... r Distance to nearest: Well .-_. Q j_t _._---._Foundation ----10.`--.------ Prop. Line _s---} ...... LEACHING LINE No. of Lines 'al--------- Length off each line...__.-----.-._ --- Total Length .-1-�Q__........._.. D' Box .-_L;l__.._ Filter Material 15- eP5---- pth Filter Material �6 -.�r ---De - --- - _------------------ Type -- L Distance to ne rest: Well / 'J-_---- Foundation ....�0 r --- Property Line .. 2 SEEPAGE PIT Depth �.... Diameter /7-�.. Number Ti%. Rock Filled YesX No ❑ L /_0_0 Water Table Depth .. ------ ------..._ ....Rock Size .a'.�L Distance to nearest: Well ._.l--QQ.f-J------------ ......Foundation ----C0.. -.- Prop. Line ----�r.._......... REPAIR/ADDITION(Prev. Sanitation Permit# ------------------ --- ----_--------------- Date __--•-..------ ----.---_-_...I rSeptic Tank (Specify Requirements) _:------_ _----------------------------------------------------------------- --^-------------------------------------------------------- Disposal Field (Specify Requirements) --._-----. .--- ----------------------------------------------------------------------------------- ----------------_----------- ------------------------- ----- ------------------------------------------ ------ - - ---------------------------- - -------------------------- ----------------.......... - -- -- ---------- -- -- -------- - _- ----- -------------- ---------------------- --------------- - --- -------------- --- _--------- (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done In accordance with San Joaquin j. 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." Signed _...----- --------- --- --------- - . . Owner By - - ----�-------------- --c----- - --------------------------------------. Jitle (If other n owner) p EPARTMENT USE ONLY APPLICATION ACCEPTED BY -. .. --------------------- -------------- - - ------ DATE fi 2 ... ----------- r BUILDING PERMIT ISSUED - - __----_-DATE ..__..-._._. ADDITIONAL COMMENTS - - - - --------------- --- - -- - - -- - ----- --- ------------------------------ -------._---------- . ---------- ---- ---- -- -- — - - — -- - -- - --- --------------------------------------------------------- - -- - ---- -----� ------- -- _- - - ------------ ----- --------- -------------j--`--- ------------- -------- n- - ---------------- -- - -- -- - -------------- --- -- ------- --------------- - -- - - -------------------U . Final Inspection by: --- ---- — -- -- ---- -- -- - - - - — -------- - - ---------- -- - -- -- ------ --- -.Date --- !(;-02% - ---------- LJOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 4 . SM