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y FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. No. 7 =77 (Complete in Triplicate) - This Permit Expires 1 Year From Date Issued Date Issued _�_ �5_�7 ----------------------- ----------------------- 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 County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . : �� r = - _CENSUS TRACT -------------- ------- Owner's Name f d---------- '�� - ---- r::_---- `- Phone ------------•--. City ------------ ----- --- -- --- - -- -------- Address ------------------ ------ ---- ----------------- - -- - - - - - - - - ----------------�. `� -= Phone .J 2: Contractor's Name -----l�_ � License #� - -f-f/' -�jC Installation will serve: ResidenceP'Aparfinent House-F] Commercial []Trailer.Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----- __ Number of bedrooms __,,`__._.Garbage Grinder p Lot Size __ -r-- S,---"--------- Water Supply: Public System and name -------------------------------------------------------------------------------------------------------------Private ❑ Character of soil to a'depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ ---Hardpan ❑ Adobe*_Fill Material ____________ If yes,type __________________________ I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) It NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK t Size----s -1 ---------------- Liquid Depth --- ------------ \ { V) Capacity 41-1,6a_14/Type Compartments ---�-__--------- Distance to nearest: Well ___ r___ -------Foundation _do`' ------------- Prop. Line ---_•- LEACHING LINE " No. of Lines -------/------------- Length of each line________, ---- Total Length ----1;-- '�..---.---- 'D' Box � ---- Type Filter Material ___ _.. ------Depth Filter Material --------------------------•---- r �-.�. rte' � n Distance to nearest: Well _ - °_______ Foundation __fes___.______.__ Property Line __ ________ Depth -141............ Diameter k:_---- Number ---------/-------------- Rock Filled Yes No 0 Rock Size Water Table Depth ------- -.----------- Distance s. to nearest: Well ----- _____________________Foundation - 4.---r----- Prop. Line ___ --------- t - ) REPA1RfADDITI0N[Prev. Sanitation Permit# ----------- ------- ---- ------------------ D e ------ , Septic Tank )Specify Requirements) --_--- - -- - � ,/y Disposa field [Specif Requirements) -"-� G��i��-�'� -----4 --. - '`' T✓�sr-w, r- '' 1' _ Cf C' 4 _. . _ ----- f' r , . �r aw existr�i Tand re wired addifiio on reverse sides I hereby certify that )'have prepared this application and thot'the work will be done in accordance with San Jo County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner o n sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----- - -- --------------------------- -- ------------------ ----------- Owner Title __. --- ------- ---��`----- BY i x [If other than owner) , � y O RTMENT USE ONLY APPLICATION ACCEkW—BY ------ 4 DATE ____-- BUILDING PERMIT ISSUED ----- - --- -- ---------------------------- DATE ----------------------------------- --- --- - ---- - ------ --- ------------ ADDITIONALCOMMENTS ------ --- - ----- ----------------- ---------- ------------------------- ------------------------ ------------------------------------------ ----- -- ------- ----- ----- 1 '�� 6-/ � 7 --incl----------- ---------------------------------- -- -------- --- ------- --- ---- -- — Date --- Final Inspec#ion bY- y ------- -------------- ------------------- 0 SAN'' AQUIN LOCAL HEALTH DISTRICT 9 E. H. 9 1-'68 R v. 5M