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r y i AOR OFFICE USE: i APPLICATION FOR SANITATION PERMIT r Permit No.7 - 1_ - • ` 2 6, (Complete in Triplicate) ------t---`------------------------ s . __-__________________ ________ This Permit Expires 1 Year From Date Issued Date Issued _3_' 6Z:Z,3 Application is hereby made to the San Joaquin Local Health District for a per mif-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 + -- G!_-•��-------- �_---- - lel ----------------- ------CENSUS TRACT -'------------ .......... Owner's Name ----/= f: °0--- -- -- ---------------�-----------------------------------�--------------- ---Phone Address '' --- Y ' ` _ '_-- city Contractor's Name ------ -0�___—. __ __ _ /__ --------------------License # ��..�_1f_9Phone -- f��- € Installation will serve: r ResidenceApartment House-❑ Commercial :❑Trailer Court '❑ Motel ❑ Other's"- --'--------------------- Number of living units:_______ Number of bedrooms ___'2 ___Gcirbage Grinder__ Lot Size --------------- i Water Supply: Public System and name ___d_y ----41..0�`____ / ----------------------------------------------Private ❑ F Character of soil to a depth of 3 feet: sand'❑ Silt❑ Clay ❑, .Peat El Sandy Loam ❑ Clay Loam:❑ I Hardpan ❑ Adobe Fill Material ______.___ If yes, type _________________________ i a {Plot plan, 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,) to ' PACKAGE TREATMENT [ ] SEPTIC TANK;[ ] Size---------------------------------------- ---- Liquid Depth -----_-------------------- Capacity --- ---------------- Type -------------------- Material---------------------- No. Compartments -------_............. i Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ---------- ------ 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 ---------------- Nurnber ------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------I------------- --------Rock Size -------------------------------- ` Distance to nearest: Well _ -----------------------------_____________Foundation -------------------- Prop. Line ---------------------- r � REPAIR/ADDITION(Prev. Sanitation.Permit# --------------_---------_--- ____ - Date __________________________________J Septic Tanks(Specify Requirements) ___________________________ ____ ) Disposal Field (Secify Requirements) ------. _ ' ______ ��_ _ ________ ------ ------ - Y I hereby certify that I have prepared (Draw s application and ired - 1 I addition on reversee side) ; e work will be done in accordance with San Joaquin County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health District.'Home owner or licen- sed agents signature certifies the following: 1. "I certify that iin the performance of the work for which this permit is issued, I shall not employ any person in such manner y as to become subject to Workman's Compensation laws of California." w. Signed ------------------ ---- --------- Owner 1 ------ Title - � BY -------------------------- ----------------------------------- --------- (If er than owner) FOR DEPARTMENT USE ONLY t a APPLICATION ACCEPTED BY --- l--- ------ --------- -------- --------------------------- ------------------------------ DATE ....3 fes.� 73------------ BUILDINGPERMIT ISSUED ----------------------------------------- ----- --- ------------------------- -------- ------DATE ------------- --------- `------- ---------- ADDITIONALCOMMENTS --- -------- ------------------------------------------------------------------------------------------------ ---- ------------------------- ---- (--------------- ----------------------------------- ----- ------------ ---------------------------------------------- -- -- ---- -= ---- ------ ----------------------------------------------------------------------------- ---------- --- Final Inspection by: � Date -- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT VVK E. H. 9 1-'68 Rev, 5M