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iM FOR OFFICE,IU --- ---------------- --- - APPLICATION FOR SANITATION PERMIT Permit No. 7 I 3 7i� - -� ------ - - � --- ---- -- ----- I� (Complete in Triplicate) ---------=------=----------------- -I- This Permit Expires 1 Year From Date Issued Date Issued 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 Rule's-and Regulations: JOB,ADDRESSALOCATION . / -----,/ �� CENSUS`,TRACT Owner's Name. moi, /°[ '1 1J_ ------------------------------------------------ _- -------------- ._Phone _7 Address --------S,#M ----------- ----•------------=------------------------------------ City -=----157';41!Ve V11----------------------- ---------------- Contractor's Name --_- .��Z'---S�`�-----------------------------License #17,7.Vf�7---- Phone JWI��__f�7.or -- I ll. Installation will•servec Resid Apartment House,❑ Commercial ❑Trailer Court ;❑ FMotel ❑Other -------------------------------------------- Number ------------------------------- ----------Number of living units..---/----- Number of bedrooms _______Garbage Grinder _ fO_ Lot Size _1P--/�JW' ----------------- 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 ---------------------------- (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,) --_ PACKAGE TREATMENT [ ] SEPTIC TANK Size_- ,;Y X-` -- ------------ ------- Liquid Depth ..---______________ Capacity/p2N -__ Type �� Material 7411__ No. Compartments ............... Distance to nearest: Well _.F_ _ __ ___________________Foundation _10_`____________ Prop. Line ,6�_ _`___:__....__ �� - LEACHING LINE ] No. of Lines ---/------------------ 1Length of each line_._AV---_------______ Total Length 140___________________ Z 'D' Boxlf_D_--__ Type Filter Material ____Depth Filter Material ----1 ..---------------------------- Distance to nearest: Well ---/Q(1__f___------ Foundation f61 ---------- Property Line 4, -�`___�_.M SEEPAGE PIT Depth --------- Diameter Jfz.___-____ Number ------------ ------------- Rock Filled Yes 'JR' No :0 Water Table Depth -----dao ------------------------ ------hock Size ............. Distance to nearest: Well _110a----------------------------- ICU-_.____-____ Prop. Line __3`r_---- .__..__ y REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date --------------------,-------------) SepticTank (Specify Requirements) --------------------------------------------------------------------------•------------------ ---- -------------- ------- ------------------- Disposal Fiel� (Specify Requirements) _________________ l \ II -------------------------------- -- -[•-------------------------------------------•----------- ----------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certifyi that I have prepared this application and that the work will be done l in accordance with San Joaquin It County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the followings a "I certify)hat 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 By ._ - I� =----------- - --------------------• Title - ----------------------------- (If, other thano ner} FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY O -- j ------------- ---------------------- DATE b__ 7 --------- BUILDING PERMIT ISSUED-------------- ------------------ - --------------------/.. ............ ------------------- . ------------ - -------- DATE - -- ------------------------------------- ADDITIONAL OMME ------------------------------- -- ------------------------------------------------------ --- ------ i ------------ ------------------------------------------------------------ _ ai, ---- -- ------------- -------------- -- ------- -- - --- -- --- ------------------------------------------ Final In section bY- -Date _-- -- --- --- -- --- N JO QUIN LOCAL HEALTH DISTRICT i E. H. 9 1='68 5M. Via. ,_ - __