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"FOR OFFICE USE: APPLICATION FOR SANITATION �tMIT - -------------------------------------------------- Permit No: 7---------------- Date 6 (Complete in Triplicate) --- This Permit Expires 1 Year From Date Issued Hate Issued �_L__ 7.�. 5'0 o f 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 Ru es and Regulations: Q i = pB..ADpRES�LO N 1 .SaE / --- ----- C S TRACT Owner's Name `� -� ---------------- ; Phone '. 16_-- Address -----`_ _ --------------"-----------------------------•---•---- ----------- - �M--------------------- City ------ -- --- - Contractor's Name 0-7-- License # j�D ------ ��7 - Phone Installation will serve: Residence ❑ Apartment House-❑,Commercial ❑Trailer Court ❑ Motel ❑Other Number of living units:------ Number of bedrooms ____1----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 f Hardpan')V -"Adobe ❑_ Fill Materia! ---_ If yes, type ---------------------------- a (plot plan, showing size.of, lot, location of.system in relati6n to wells,-buildings, etc. must be placed on reverse side. NEW INSTALLATION: (No septic tan pori seepage pit permitted-if public sewer is available within 200 feet,] f PACKAGE TREATMENT [ ] SEPTIC TANKXa Size,.____ x �' r -_ ---'•'-- ------------------------ Liquid Depth ---a�--.�..----•----•--- 0 .A� � /� Capacity.]? ___4=- Type -_ �- ----- Material- '+* _c--- "No. Compartments -----------------_--- _If F ._ r Distance to nearest: Well __ "1trO___ f'__ -----•Foundation _ALP------- Prop. Line---- LEACHING LINE No. of Lines ___------7-------x Length of each line_____laK7_____________ Total, Length '--2-055--__-_;_._._. D' Box es^✓Type Filter Material Depth Filter Material „""__1 __t- ----- i~ Distance to nearest: Well "- ---� ------------------------_ _ Fou�n_ d,a#i -----1--�- �-----lb-Pwrop , Line i/ - � er ---------------- D ms ' SEEPAGE PIT Depth ti ' - N � Rock Filled Yes rNo ❑ sI ___ .___Water Table Depth _____--------- ..Rock Size ------- - Distance to nearest:;Wel! -------h..........................Foundation f ------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ______________ !---- Date _-__-_-----__--_----_ _ _. ___) - SepticTank (SpeRequirements) -------------------------------------------------=----------------=--------------------------------------------------------------------•--•- Disposal Field -(Specify,,Req uirements) - '. 3 - -- ------------------------------------------------------------ -- - - ----- ---- -------------" -- --------------------------------------------------------------------------- --------------------------------------- I (Draw ei isting and required addition on reverse side) 1 hereby certify that I have prep'fed 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 fhe following: a "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 become subject to Workman's Compensation laws of California." Signed '' <�.✓ Owner ----------------------------------------- BYr -=-- -`--------------------- ----- Title ------- -- ---------- (If of r than ower),* f' f FOR DEPARTMENT USE ONLY J APPLICATION ACCEPTED BY f -------------------------------------------- ----------------. DATE BUILDING PERMIT ISSUED - ----------------------- --------------------------------------------------------------- ---- ------DATE -- ---- ---------------------------------- ADDITIONAL COMMENTS--------------- -------------------------------------- ----------------------------- -------------------------- '-=--------------------------------------------- ----------- ----------------------------- ----------------------------- - ----------------- y .A ___________________________________________ _ _________________"__________________._______________________.____.______________-____" -_--------------_-_-----. ____-___-____ Final Inspection by: ---- - ; ------ ------ --- ��' -7j Date ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _..__._.. .. t s`7