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FOR OFFICE USE: APPLICATION FOR SANITATION PLAIT / Permit No. .7 -�-� (Complete in Triplicate) ----._.-._..... _..-----.---------- Date Issued -�:..Z� j ----------------------_______-__________-_-- 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: JOB ADDRESS/LOCATION ..2--7-- -fir LQ-- S_-I-�'�.............-------- .... CENSUS TRACT S y — ..Z- --_------- Owner's Name __ !'lrtht7l:. - 'C.t r- 7 i Ee <L-------------------- --- ------- - - -Phone ..-3-G.-9 _1Y6---�4`--- Address �7 - - `` - - ------- ----d6 VV-�- -----_ - - -- -.r-.Ck/'.------------ -- ------- city ----- - --> -.._ Contractor's Name --/%" '" ' ;T "Ayo y _lrial'--- att.kAicense # .a�rr*-..-".t -i-7 Phone -La.-. -- 1-` f�- Installation will serve: Residence ('Apartment House-M Commercial [-]Trailer Court 0 Motel ❑ Other Number of living units:__,-.... Number of bedrooms .---�r..Garbage Grinder -------- Lot Size ...dZene-je Opec ----------- Water Supply: Public System and name -..__---------- '....._------------------------------------------ -------------------------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam V Clay Loam ❑ Hardpan jo 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,) C PACKAGE TREATMENT [ ] SEPTIC TANK j�] Size.-.-5/1_10-_Y .-- S __._---....__ Liquid Depth -.--.f --...._----.. Capacity _1 6-- Type A,4- Material-_ekiri,tnt „ No. Compartments -a ------ ....... Distance to nearest: Well -..__ C_-P_-------- -------Foundation -------- Prop. Line .... ................ LEACHING LINE �J No. of Lines ...A"___---...... Length of each line -------- - Tota[ Length - ............... 'D' Box .-7-U_ Type Filter Material 19-Ir--------- Filter Material -----/P------------- .................. Distance to nearest; Well .__J 0-'-4--.--- Foundation ------ Property Line ----------------_--- SEEPAGE PIT Depth Diameter 33-.----- Number,__...i2..._. .--.-- Rock Filled Yes No Q Water Table Depth __?Q-------------------------------------Rock Size -. .------•------------._- Distance to nearest: Well _14"--.-'r--------------------Foundation ---/. IP_'__--- Prop. Line -_S�--------------- REPAIR/ADDITION(Prev. Sanitation Permit# --------______-- ------.- ------------ Date . ------------------------------..) Septic Tank (Specify Requirements) ... --- ------------ ------------------- Disposal Field (Specify Requirements) __..------------------------------------------------._---------------------------------------------- ------------------------------------------------------------- -----------------. -- -------- ----------._ ..__------ -------------- -.......... ...........---- ---------- ---------- --..__. ------------- -------- -------..... (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." Signed ___.-----------------------_...----.._......-..-----------------------------------.-. Owner By ------------ ----------------.-.. - -- - ------------ Title ._. ------ (If other than owner) FOR DEPARTMENT USE ONLY J/ APPLICATION ACCEPTED BY --- - ---------------------------------------- ------------------------------. DATE ---------------- BUILDING PERMIT ISSUED ---- -------------------------------------------------------------------------------------------- ---DATE ADDITIONAL COMMENTS ...------- ------------ ------------ ---------------- ------ ---- ----------------------------- ------ - ------------------------- ------------------- - .... ----------------- --- ------ 3 l Final Inspection ---_Date< .-._.--- . ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev- SM