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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ,/ F, _ Permit No. __7-----G-� / C (Complete in Triplicate) f ----------------------------------------------------- This Permit Expires 1 Year From Date Date Issued _.- --------------------------------- _ -------------- -------_ Application is hereby made to the San Joaquin Local Health District -for d permit to construct and install the work herein described. This application is made in compliance with CountyOrdinance No. 549 and existing Rules and Regulations: _ All ^•--- l T. t?. ' - CENSUS TRACT -------------------•.---- JOB ADDRESS/LOCATION '4� 0(01------- 44 Phone ---------- ------------------------ Owner's Name .-- ------------- - -itY c.,C-T .l S Address ..... Io SOX --��--�--�--------------------------- Contractor's Name __ %l. 1��r----� ----------License,# f3- Phone - '7-p Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other _ _ -- Number of living units:./l� Number of bedrooms ---Garbage Grinder. ____-- Lot Size- 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 pian, showing size of lot, location of system in relation to wells, buildings, etc. must 'b'e"-placed on preverse side.} NEW INSTALLATION: (No septic tank or seepage pit permitted if public .,sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] /�,J:Size---4;_X_17_'----------------------------- Liquid Depth __� --_...------ Capacity -- -s C�_-.- =, Type)AG, _ Material _Z�_ r.&.r.No. Compartments ___ _----._.__. Distance,,to nearest: Well .....3Z)-------------------------Foundation __1A9-------------- Prop. Line ___ V LEACHING LINE No. of Lines _._____ ___________ Length of eachllirle_.__X ------.------ Total Length :- -----------_- k-----l t r I 'D' Box� Type Filter Material Depth Depth Filter Material ___- ...................•------------ rn, Distance�to nearest: Well _ Y--. -Foundation .-1 ----- __-____ Property Line. ----'�---------------- - . f rr ` , SEEPAGE PIT Depth _ s_ Diameter _ ---- Number ---------------------------- Rock Filled Yes o 0 Water Table Depth ---------7S-------------------------------Rock Size ----�_� ` '!il_------- P ----.Foundation /_Q--------Q--- Pro Line Distance too nearest: Well _____ Q�- fip '1 - ------------------- - - - I � • � REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ____----.-------------------.-----1 Septic Tank (Specify Requirements) ----------- ---------- --------------------------------------------- •----------- -------------------------------.-------------•--------- --- Disposal Field {Specify Requirements) ------------ ---------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------- - (Draw existing and required addition- -- F : dition on reverse side) I 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 licen6 I sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to beco ubject to Workman's Co ensation laws of California." Signed ----- t ---------------. Owner t ----. Title ----------------------------------------- her than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .--- --- - --'---------------- --------------- DATE -- _... BUILDING PERMIT ISSUED ------ - •--DA -------- ---------------------------------- -------�/-------- L_C � ` � [r'+ rw- - - ------ ---------------------------------------------- ------------------ - ------------- ---------------------------------------- - - --------- - --------------------------------------------------------------------------------------------------- - -=- -- u� ------------- FinaE Inspection bY: -------- --------------------- Date �! __.- -/ S N JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev.