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E�� cDR OFFICE USE APPLICATION FOR SANITATION PERMIT Permit No. 7-Z" :.. . A (Complete in Triplicate) . ................. ............. Date Issued .J.:_7r...... 7 Z - y..__._ , This Permit Expires 1 Year From Date Issued € + described.This ❑ notion is made 4 A lication is hereb mode to the San Joaquin Local Health District for a permit to construct and install the work herein pp in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS,/LOCATION _... rx---% -,_V,,...:.=r: .CENSUS TRACT ...._ _ Owner's Name4 ' - 7/(l" � _ -� phOe - Address ..... C --"--...City ._...----- " � F .:. Phone - .: icenseContractor's Nome # installotion will serve: Residence j'Apartment House-F]Commercial❑Trailer Court I❑ Motel❑Other..... -----------..... --- ' Number of living units:---/ ....... Number of bedrooms .. -__--Garbage Grinder -----__.... Lot Size Water Supply: Public System and name ....................... ...... - - ..... --.....- Private a Character of soil to a depth of 3 feet: Sand'D Silt❑ Clay ❑ Peat❑ Sandy Loam 0 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.I NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [] SEPTIC TANK[] size.....____............................. . quid Depth .- _ ............-- . Li P Capacity.... - - -- Type ------------------. MateriaL------------------. No. Compartments ......... Distance to nearest: Well ....-----------------------...-.----Foundo'tion..--........-- -- Prop. Line LEACHING LINE [] No. of Lines ........................ Length of each line..........---...--.......... Total Length ------------ 'D' Box _-.-- ---- Type Filter Material ....................Depth Ic0ter Material ................................ _---------- Distance to nearest: Well ------------------------ Foundation ......-------------.... Property Line . t SEEPAGE PIT [ ) Depth Diameter --------------- Number __-_.-.........---...- Rock Filled Yes ❑ No i❑ Water Tabie Depth .......................-----------------.....---Rock Size.............................-- Distance to nearest:WeR ____-----------------------------Foundation .................... Prop. line ---......-.._._..._-- i REPAIR/ADDITION(Prev. Sanitation Permit#---------------------------------------- Date ..._.-..__-.--..................) Septic Tonk(Specify Requirements) ....................................-r------------------------_...............--- ........................._.............. Disposal Field ISpecify Requirements) KCL - `2 ... Jt ::--:..,�z---- ----------------- C'_ Cy % 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 at licen- sed agents signature certifies the following: i "I certiFy that in the performance of the work for which this permit is issued,1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed....................... ... ✓ .... .`..... Owner y. k By. ............................................. ------ Title................'--...................................... Of other than owner) -FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY... r - ° 7r.-.Z- --------------- 1 � ..�=«:;:.,,.�._�-F,�-Fz...--��.................� - DATE BUILDING PERMIT ISSUED..................................................._.............-.. .....DATE-------.............. ADDITIONALCOMMENTS- .......................... ............................ --------------------------------........ ....... ... ......... -----------------------.------------- A..... ---...._..........................-- --.._...--................ --..--- _-- - --- ..._- .......... .... Final Inspection by:..-.. ---------------Date.. .. ✓.:. -' SAN JOAQUIN LOCAL HEALTH DISTRICT ` E.H.9 1-'68 Rev.5M 1 �i k 4 + i s I a