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FOR OFFICE USE: �'�^�- APPLICATION FOR SANITATION PERMIT -------------------------- ► """ Permit No: 7 (Complete in Triplicate) -------------------------------- This Permit Expires 1 Year From Date Issued Dote Issued 1 L-f 3 — //0_ 0 y 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 C 1-,;VW491. 4! --:T�' , 50,6 el-',? -.---CENSUS TRACT --------------------------- Owner's' Name _ ��5_ - 2 5- -[_� --- Phone Address t_ � rrE u ,tet / /7 --------------------------------------- --��-� -T---��-------------------------------- City �CGO�i _C....�•�,F � FF - Contractor's Name __. # _c�C-¢/7� Phone Installation will serve: Residence ❑ Apartme use❑ Comme i Frailer Court i❑ t 4 Motel ❑ . Other --- --- L� __ ___-_ _ _ Number of living units:------------ Number of bedrooms ____________Garbage Grinder ------------ Lot Size -----------_________________________________ Water Supply: Public System and name -_------ .�- -------bj --t-D-----------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ 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.) op� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) 1 PACKAGE TREATMENT { ] SEPTIC TANK[ ] Size-4:;7X__4a.__ /4------------ Liquid Depth ----- 2______________-7- Capacity C?___ Type?€M.C4Vt_ Materia'I__ ..__.---- No. Compartments ____------ X' Distance to nearest: Well ------/-&19_'_�______________Foundation -./99--- Prop. Line .... ------------ LEACHING LINE [ ) No. of Lines __ .57-- ------------ Length of each line---- .__.------ Total Length _.._-_.5'�90-____-_-__- 'D' Box Z�1xe._-- Type Filter Material _ _ _ __Depth Filter Material _____Itf_________________ ____________ 0-0 �. Distance.to nearest: Well _ -"f------- Foundation _ Property Line f I SEEPAGE PIT [ ] Depth __ ---------- Diameter _______________ Number ---------------------------- Rock Filled Yes ❑ No i[ Water Table Depth ------------------ Rock Size r Distance to nearest: Well -----------{------------__------------_ Foundation -____________.____ Prop. Line ........... i REPAIR/ADDITION(Prev. Sanitation Permit# -_- _ +_________ ____________ __________ Date } f --------•------------------------- Septic Tank (Specify Requirements) x __ __ Disposal Field (Specify Requirements) --1�tii`_.�_ ._ `_ --------------------- -------------------- ---------- --- -- --------- --- , -------------------------------------------------------- ------------------------------------- - ------------------------------------- ----------------------------------------------------------------------- ------ -----------------------------------------------`----- {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 V'th—San Joaquinf Local Health District.-Home owner or licen- sed agents signature certifies the following: � ,}--.--�;,�( r....: t "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 becom s bject to Workman's ompensation laws of California." Signed ------ ------ ---- - - - - - -- .�---_(r ----------- Owner ---------- --- BY ------- -= Title - --- ------------------------- ----------------- - (If o er than owner] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ _ p X" ------------------------ ATE ` - BUILDING PERMIT ISSUED --- - -- --- --------------DATE --------------------------------- ---- ADDITIONAL COMMENTS __ ____ ____ ___ __ 6- -- --------------------------------------------------- ----- ------------------ -------- ------------------------------- ---------------------------------- ------------- ------------- --------- ---------------------------------- -- ------ - - Final Inspection b //�� j --- ---_----- P Y� - - --------------,Date _ SAN JOAQUIN LOCAL HEALTH DISTRICT > E. H. 9 1-'68 Rev. 5M