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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7 --o Date ...... r Date Issued / . ............ This Permit Er 4ires,11Year From Date Issued Application is hereby made to the San Joaquin Local Healih District for. a permit to construct and insioff the work herein described. This application is made in compliance with County Ordinahce No.549 a d existing Rules and Regulations: !. . ......CENSUS TRACT ------ ------------ JOB ,ADDRESS/LOJ. i N . �. /� ..� lti/ 4.............. / ' '` Phone..i..�� --7/.ar�e Owner's Name .. ` -... -n 1�'— - = ..,�J. .._......`.. _ . Address � �- > c. ..---...._....... City Contractor's Name ...... r� cL ..License # Phone Installation will serve: Residence Apartment Housed Cornmercibl ❑Trailer Court 0 ` .. Motel ❑Other ....-------- ... ........ .:............. Number of living units:---/....... Number of bedrooms Garbage Grinder ............ Lot Size '��✓�=� ----- JJ J i Water Supply: Public System-and name .. ....._ - ....... --• .................. ...--------------- -- . ... ---• . ----..... Private ❑ f Character of soil to a depth of 3'feet:�Sand'❑ Silt{. Clay 7]--PeatE] Sandy-Loom 0 ' Clay Loam Ci Hdrdpon ©--Adobe----Fill-Material ..-._.. .. If yes,type- (Plot iplan, 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,) } ' PACKAGE TREATMENT [ J SEPTIC TANK 4 I' _ Size....................�............ .. Liquid Depth _---...._ -_-----_--- Capacity --- . ----- .Type ----------_---. Material. 7 - .. ... No. Compartments ........................Jr Distance to nearest:,Well ..................• ..__.__Foundation.�, ....."7.-.+....... Prop. Line ..__........::_.....-. f•. LEACHING LINE No. of Lines ....... ...... .... Length of each line....��lJ.. �... Total Length 14). :............ 'D' Box ..../..... Type Filter Material ---...Depth Filter Material ...... .. ........................�._. I Distance to nearest: Well . ......� ,_..... Fountldtton�- ..._ roperty-Ltne--:. ..-:..--. -4-�--P Tom. SEEPAGE PIT Depth' . ... c !/'`Diameter . . �T �Numbe- -----------�. ... Rock Filled Yes �' No �J � t Tn � I Water Table.Depth :. - .. 1�....... ------Rock Size ------- - --- ---------•-- 1 Distance to nearest: Well ...............+.....Foundation .�� Q.---. Prop. Line r REPAiR/ DDITION,(Prev. Sanitation Permit# -•....................................... . Date ......._,... .... I I _.-------- -- --- Septic Tank (Specify Requirements)•°....._�.........-.: �.Q._..• �. %..- 'c-c...1�--- �1.-•••• 1 Disposal Field (Specify Req uirement's)..�'.......__... ---C.�� •-- - - �...... ............... p.._. t 1 ` .. ...................... ----------- �... ......•--._c..•--...... .......... (Draw existing and required addition on reverse side) I hereby certify that-,Ia have prepared this application and that the work will be done in ccordance 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 ............................ . 1 ----- ------- Owner., By -� � c Title .... Lam.. .. _ ........ ..'Ev - If other than owner) ( r FO DEPARTMENT USE ONLY _ - - - - APPLICATION ACCEPTED BY ........ ..:.. .. . ....._....._ �. •. .-__ _ DATE= 7..�J -r-J.. •• -••;� • ..... BUILDING; PERMIT ISSUED .-.. .. . --------- ------_------ ....... . _.....- ---....DATE ...'- ADDITIONAL COMMENTS ................... ....-- ''= --....... ............. ...... . .`................ ........ ..: .. .............I._.__.....--- ------. - .._. ....._...-- -------- -- -:. Final.Inspection by: ._.....-. :_. ... . Da t JOAQUIN LOCAL HE LTH DI RICT . E. H. 9 1-'68 Rev. 5Mf 1