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FOR OFFICE USE: ' & ! APPLICATION FOR SANITATION PERMIT Permit No. 7 - ~ (Complete in Triplicate)"i ��.. x Issued �",lQ._.76 ................................... �: -:.....'�.'. ," . Thfs Permit Expires 3 Year From Date Issued ~-Date Application is hereby made to the Sari Joaquin local Health District for a permit to construct and Install the work herein described. This applicationgs,made in compliance with County Ordinance No. 544 and existing Rules and Regulations JOB AaDR SS/IOCAT€ON rS.o_7..... 1S.....11�=.:, T:.---.............. :....CENSUS TRACT .. Owner's Name ...:........:........... i r:.' .Phon ......e ... . .. .......... Address .` �1.. ,/�ll.ld++.rt=.7r. 7r� .. . . Y� aty .C. e7.0—,l. � �........... . Y Contractor's Name . ' ' .License # ,S'��/.?. '. Phone ,�r�� ? F installs#ion will serve: Residence©AA.partment House] Commercial oTraller Court }] ilMotel ❑Other--DS..••• - Number of livingunits ... Number # of bedrooms ._ ..---Garbage Grinder .._._-..... r� "�'- `� •,Lac size ...........................................� 1 Water Supply: Public S stem and name - �r•- -� 1, I t e�.t � Y ...��:...rcllr�. ••••..... .......... ---....................... Character of soil to a depth bf 3 feet: ' Sand'❑. Silt[} Ciay Q Peat❑ Sandy Loam'o Clay Loam o 1 = Hardpan 0 Adobe Fill Material ............if yea"type°............... ........ .. : e (Plot plan, showing"size,of lot, location cf system in relation to wells, buildings,etc.-Must be placed on' reverse side.} NEW INSTALLATIONS (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT .[ N SEPTIC TANK i } Size......... , Liquid Depth ....................... Capacity .... ............... Type .................... Material...................... No. partmertts .Com � ..:.....:_............ ,ante.to nearest: Well ....................................Foundation ....._............. Prop. Line ......................ANo.� i LEACHING LINE est,of Lines ----..1•--------- -.. Length of each Tina-._..j ................ Total Length ,2 '.............. .. .` 'D' Box L.�.tu_. Type filter Material ��J.AX..Depth Filter Mat tial ........................... xrs r,�1 y `,� i ante to nearest: Well ---/JI-Ia ?..r. Foundation f t .... -•1�:---......:.... Property Line `:.. .............. SEEPAGE PIT Dep#h `r - ti ...... Diameter _ .-•.--- Number ......_..e............. RS& Filled Yes No p Water Table Depth . �:...................Rock Size .• X,f.J2�p ..._ Distance to nearest: Well .....................Foundation ..A9........-: Prop Line --Jr-.--- REPAIR/ADDITION(Prev..Sanitation Permit# ............. ...... ...............•..__ Date .. .. - - k ..=........ } Septic Tank (Specify Requirements) Disposal Field (Specify 'Requirements) q • • ' Draw existing d 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 Law' s, and Rules and Regulations of the San Joaquin Local Health:District. Home owner` 4r licen- sed agents signature certifies•the following: _ " "I certify that in the'perfgrmance,of the work for,whicii_thii permit is issued; 1"sshall not employ any person in such manner as to become blect to Workman's Compensation laws of California." Signed .-- -- I - _ - --- - 1, .7'!�:`..- -- Owner BY ------------------ -- . ----- ... Title ..... Ilf other tha owner).E.-. �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�_.-.-- _� ----.--...DATE ..-•- �jl ------ BUILDING ADDITIONAL COMMENTS __.- MIT ISSUED _ _ ......__.._...-Ile ©ATE - _ e ��c....r , .- _� -•---••------------ ---------- --------_---------• .------ - _ ------- ------ --------- --------------------------------------------------------------------- ----------- -------- Final Inspection by: _.__._. - ! i � ,• ----•Date ..(}.=��....................... EH 13 2h 1--68 AN AQUIN LOCAL HEALTH DISTRICT 874 3M