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a FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7-7 (Complete in Triplicate) ................................................. .... , ...g:�r-�... This Permit Expires 1 Year From Date Issued Date issued Application is hereby made to the San Joaquin Local Health District-f r a ermit to construct and install the work herein described. This application is made in compliance /with County Or/dinance No. 54-9 and existing Rules and Regulotions: JOB ADDRESS/LOCATION .:........?666_ . .._-.z46 4,t:4,NkFJ ..............CENSUS TRACT ......_..----•--.....:_:._ Owner's Name a�N -_.... Phone .` 3._'. 31 .......... Address . --- ;.... .......... :-----------........---. CitV ------ '` ..._...._......__. ........ .............L n amnse # ----- PhoneContractor's Name .--------- Tc - .. �..- Installation will serve: Residence(Apartment House-❑ Commercial []Trailer Court i Motel ❑Other ..........:.......... 3.__._..___Garba aGrinder ....-.._:.__ Lot Size .._�. . ..... .......... Number of living units:......_.... NImber of.bedrooms—..-_�. , g Water Supply: PublicSystem and name ---- ...-••------•--••--------•---. ------- ........------ ------ ------------------------Private1. ❑ Peat Sand Loam Clay Loam ❑ � Char'acter of soil to a depth of 3 feet: . Sand❑ Silt❑ . Clay ❑ ❑ Y ❑ Y Hardpan {] Adobe Fill Material - . ----.._. If yes, type -- ...... (Plot plan, showing size of lot, location of system_in.wrelatior►to wells,-buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit peri ed Lif public sewer is available within 200 feet,) PACKAGE TREATMENT I ] SEPTIC TANK. ] Sfze------------------------- ---------------------- Liquid Depth ....._..... .............. Capacity Type ........ Material------- No. Compartments ........ ........ C1 ! _ _ . ."_".'" ............. Prop. tine - ----. ._...------- pDistance to eare_stWelt".- ._ r"' Fu { l �o Length of each line i....._. Total Length ..........-•................ . LEACHING LINE No.B%Lines 9 � >`. -_ . '"'' iypelFilter Material --------------------Depth Filter 9Material ..........................------------.....T Distance to-H arest:-Well~- '----..._ Foundation ......t___ Property Line ---------------------•-••�1�- _ s SEEPAGE PIT { ) DepthDiameter ................ Number ..-.---- .:. ;..._.`,_....--- Rock Filled Yes ❑ No ❑F ( Water Table Depth -..--------- ---------• --•--...Rock Size ... .................. i Distance tonearest: Well .................. .Foundation ..........-- ....... Prop. Line ............... I REPAIR/ADDITION 1Prev. Sanitation Permit# ................-----..........-............ Date .....................I.............I Septic Tank (Specify Requirements) .... ............ .. Disposal Field (Specify Requirements) ---......L�� 1�.2 .... t_�`�,.. ...... ............... ....... ...... l ------------.8" S- .. r. �-- - ----------- ---------- ...........---.-...- ----- . .......... .................. ------------ --- ............ ........:.......... .............. ........... ...------ (Drdw 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 . Horne owner or licen- i 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 Workma Compensation laws of California." Signed ------------------•------- - Owner BY ._. --.. . .. . ...... Title (!f o er than owner). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._. d-. DATE . �'... ..�= .' _.... BUILDINGPERMIT ISSUED _.... •. ..... .......~:-":--- ---•--...... ............__.-DATE --- ........................... ADDITIONAL COMMENTS ............. --------- ------------------------------------------------------------------- .--------- -------- . .......................................... ....._........._.._.. .................... .. - '` -�. -- ............... ---....... .--- ----.._. ---------------------- --------------------------- Date Final Inspection by: ............... ..__.--.. a e ... . •-- SAN JOA UIN LOCAL HEALTH DISTRICT I 7/72 3 ,K r ,. I 'A7�i r �An. n_._ ria ,. ..,.. _ _