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FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT <br /> ...................................I...•......... Permit No. 7.Z."..3.G.. <br /> (Complete in Triplicate) <br /> ......................................:...... ........... <br /> This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San oaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinonce No.•549 and existing Rules and Regulations: <br /> r <br /> JOS ADDRESS/LOCATION ...CENSUS TRACT ... Y7.............. <br /> Owner's Name ... <br /> !2.7.-r�----- ......................... ------- ----------- -- Phone ....... .... ...................... <br /> Address .....................% 6.v/....... .. ...�J�7g- <br /> -tor's <br /> .... City - �L.`-xJ........Contra• Name ...._....�_oit rum- -....-_ L; .. +��s�License # I .� Y... Phone .............................. <br /> Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court 0 <br /> Motel ❑Other <br /> Number of living units:..... - Number of,bedrooms ....2.....Garbage Grinder ............ Lot Size ... --------------- ? <br /> Water Supply: Public System and name ...... ..... . ..........._.--•---------. ----•--•--- ......................_......................Private <br /> Character of soil to a depth of 3 feet: Sand ❑� Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 <br /> 4 - <br /> [ Hardpan ❑ Adobe C Fill Material ..........., If yes,type .................. .. . . <br /> (Plot plan showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank <br /> =or seepage pit permittedrtf public- sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK'(] Size T .X_9 X= r �'---------------- Liquid Depth .�...._................. <br /> ( Capacity 1p.e-,�.U!�:(Type - ed.. MaterialNo. Compartments ..-5.X................ <br /> Distance to nearest: Well _--._.___-�"�.�................Foundation ...�.�..:.._....._. Prop. line _._..w...�.......-- <br /> LEACHING LINE [Yr No, of Lines --------- Length of each fine.-----I:tl_.P__.'......... Total Length .._..tjc.--------------- � <br /> �; <br /> 'D' Box �^---.. .'Type Fil*TMaterial ...5. ......Depth Filter Material ...0................................... <br /> / Distance tonearest; Well Jr........... Foundation .:.....1. .I......_... Property Line .5................... <br /> SEEPAGE PITS (K Deptfi� .�. . Diameter _�.� ...... Numbe. ......a................. Rock Filled Yes [A No -C] <br /> 1 • ._...._.Rock Size .._I`�I��[X.:�.�._._.. <br /> } Water Table Depth'? ..................... r <br /> LDistance to nearest: Well ..........j.d �.:..............Foundation ...1:E'.... ....... Prop. Line ..tet <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _._..._....................._............_.. Date _.-_ ................... <br /> Septic Tank (Specify Requirements) .-.-•------------------.--------------.--...-..--.-.-•-•---•------------.".----- -- --------------------------- <br /> Disposa'I Field (Specify Requirements) ----------- ....................................................... ................ ' <br /> ! .............................................................--...................................... ..................... . <br /> ( .................... ..............._. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed .....'....................................... ------ .- Owner <br /> Ike— <br /> B 4. �- - <--`-Ike- � 7itle,.0.0_3 t a,E.�w ------- ---------------------- --- <br /> y ..._.. / <br /> (If other than owner) <br /> . FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ."-•"- --•--".-............................................. DATE 3.'.3L.'Z ----_----------- <br /> BUILDINGPERMIT ISSUED ------------------------------------------ --------------------------------------------------------------DATE ............................................ <br /> ADDITIONALCOMMENTS ...........-•--" -"............. .................................----................:..........................._..._...........I...................----•--- <br /> ..................... .. ..-- ---......----- .................................................................................................................................. <..... <br /> ................................••................ .... <br /> - •-----------•--•------- -----------*------ ---------------------------- <br /> -•............... .----"--..-..._-•-•-------.. <br /> ............ ... . . . . ...._._........-----• .........................................----... <br /> Final Inspection by: .. <br /> .... - �. --............................................ -•--- ._Date y i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M , <br />