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{ FOR OFFICE USE: \s 4 -4- APPLICATION FOR SANITATION PERMIT ............... ................ Si 2 (Complete in Triplicate) Permit Na. ...7 - ... .... .......... ................•-....--..................-- ��- .............. This Permit Expires 1 Year From Date Issued Date=issued .---...i...... . _ . 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 Count Ordinance No. 649 and existing Rules and Regulations. $7 J ADISR�SS/LOCATION _� __�. �� `. ��`......CENSUS TRACT .......................... Owner's Name � .,, /f f f� .....- ......... --- Phone .................................... y -•=•-- Address .-.- ....:.........••---•-•--•-----......- ................ ................ City .67.40,G_l / ...... Y .. Contractor's Name ...-- �� --'. �� _41-Ae. --..I...................License # �a'✓`. . P h a n e (? " ....... Installation will serve: ! Residence Apartment House 0 Commercial ❑Trailer Court 0 Motel ❑-Other ...........:=---............................ Number of living units:.,- .-.- Number of bedrooms ,, __.=_Garbage Grinder , Lot Size, °✓................... Water Supply: Public System and name ----------------------_ ..-..............---------------................................ ..-.. Private Character of soil to a depth of 3 feet: Sand❑ Silt[3Clay [:] Peat❑ Sandy Loam C] Clay Loam ❑ A l Hardpan ❑ Adobe;9 Fill Material ............ If yes,type ............................ (Plot plan, showing size of lot, location-of system in reiatior±io wells;bZildings, 'etc. -m'u-st-be placed on -reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) SEPTIC TANK Size_..................._-----.-_---...._.------- Liquid Depth ...:................. ..:.._ t Capacity --,..... No. Compartments ........._.. P Y .................... Type .............._.-... Material------------'- ._........ Distance-to-nearest: Well. ......___•--.-'...................:.Foundation -----_--------'----- Prop. Line .... ................. V LEACHING LINE [ ] No. of Lines ........................ Length of each line.------------- .......... Total Length ...................-........ 'D' Box ------------ Type Filter Material ....................Depth Filter Material ..................... Distance to.nearest: Well . Foundation ""' .. Property Line SEEPAGE PIT [ ) Depth ..................... Diameter ..=._..--T--Number---.:-....... .....:-_.......- Rock Filled Yes ❑ No Water Table Depth -•--•-----------_........:.....••-•••.........Rock Size ................................ [(stance to nearest: Well.........................................Foundation ......... Prop. Line ...................... REPAIR/ADDITION(Prev..Sanitation'Permit# ....:....................................... Date .................................. Septic Tank (Specify Requirements) .................... ... .......... ---- Disposal Field (Specify •Requirements) .- . ..... .O. --_-+�, ioj � Y------------------------------------- ........................ ................................--------- ...........................................-.----------------------------------------------------------------•-------- ............................ (Draw existing and required addition on reverse side) ti 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 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 4 as to become subject to Workman's Compensation laws of California." Signed --------------- ------ - ........................--- Owner BY _ ..... >s'. -- - ----•- • Sitle - . ...... .......:................... . (I er than owner) • F I. FOR DEPARTMENT USE ONLY. APPLICATI N ACCEPTED BY .--.1. ` �-J7 :.. ..-•-•=---------------------- DATE-. -- f -.. BUILDING PERMIT ISSUED _1............. ............... �. .:. :. -------------------------• •......DATE ...- .............................. ADDITIONAL COMMENTS ?! -------------------------- ........................................................ .....---------- . ...... .....................- ...-..----•• '�. ..............•- .....-.................•----------... .-- -- ...... ---•- Final Inspection by: ........ ...:: ...... . ........- Date t _. .�; • �,_..-. o , ,,,SAN J A�Q.U_INJOCAZHEALTH DISTRICT !_ E. H.13 24 1-'68 Rev. 5M 1/72 3'M