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tab S�q toto, N Z ( v FOR OFFICE USE: ! gpp`ICATIO FOR SANITATION PERMIT ` - Permit No.7 _-7 `t (Complete in Triplicate) ---------=--------------------------- ------------------- -------------------------------- ------------------------- This Permit Expires 1 Year From Date Issued Date Issued 6d-:7/6 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 .%5_OT_OD_O_ p�f}_.S, -D_�__ C ,__ -lr�•S�-_ ^--�_______ CENS TRACT •- cr .. Owner's Name/ AC_A4 L-�--- T1s_.. - ------ ----------------------------- -------------------- ---- ----------Phone 'c�l'/5=-2-*2--•Z:'-W-7 Address M.�cQ City ' ` �'f F L� Contractor's Name ________ ----__.License # __i��I�`Phone _�6�_~3�'S� Installation will serve. Residence Apartment House,❑ Commercial ❑Trailer Court l❑ Motel ❑Other -------------------------------------------- / Number of living units:____ _______ Number of bedrooms ----I------Garbage in r _________ t Size _- lP©_____T�__.�_�._..... Water Supply: Public System and name -7 -------- �_ ._ ._r� Private ❑ . 7 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------ __-____.__-_______ Liquid Depth -_-- .-/--_- Capacity 12--a_0„__ Type at_ Material__ No. Compartments _.____- � o � Distance to nearest: Well ____ __ _ _ _____Foundation ___-_____ Q.... - �-- - - - - Zfl------- Prop. Line --------- -•-- - LEACHING LINE No. of Lines _______ f Q W ________ Length o each line______'�z'�a ________ Total Length ...._.._.. D' Box __�_____ Type Filter Material _ -- 1 . Depth Filter Material ____/ .............................. .... Q � l Distance to nearest: Well _______ Foundation -----------1 Q______,__ Property Line --------- ....... SEEPAGE PIT [ ] Depth ____________________ Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ----- -------------- Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) SepticTank (Specify Requirements) ---------------------------------------------------------------------------------------------------------------------------------•- ........ Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- --------------------------------- --------------------- ------------- -- -------------------------------------------------------------------------- ------------ (Draw existing and required addition on reverse side) 1 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: "1 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 bec a ubject t orkman' Com ensatio sof Cali nia.” Signed , -- ---- ----- .PP-----Cwner`— �� -�. BY ---------------------------------------------------- -------- Title (If other than owner) FOR DEPARTMENT USE O Y APPLICATION ACCEPTED BY -------------------------------- ------------ ------- - _`_ . DATE �Gp-� - C� BUILDING PERMIT ISSUED -------------------------------------------------------- --- DATE ADDITIONALCOMMENTS -------------------------------------------------------a ---- ----------------------------------------------------------------------------- S -- - -------- FinalInspection by: ------------ -------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DIS ICT E. H. 9 1-'68 Rev. 5M