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7 FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . . # Permit No. ___7�-f /Of Z49 (Complete in Triplicate) Date Issued __.�1 �'9� � r This Permit Expires l Year From Date Issued A lication is hereby made to the San Joaquin,Local Health District for a permit to construct and install the work herein pp described. This application is made in compliance with Cou y Ordinance No. 549 and exp i�Rules and Regulations: _ :----CEN5US TRACT JOB ADDRESS/LOCATION--- -- ------------------------'�' _ �{ ----- ---��- ----- ''- - = --Phone -------------- Owner's ------ - -- Owner s Name ------- _ -_---- - -. - ' 'a Address -."-- [ 7 --- e�.---- -- --- -----License #,� �� _7-_ _ Phone ------------ Contractor's Name _-_---- - � t Installation will serve- Res'dence Apartment House❑ Commercial ❑Trailer Court Motel ❑Other --------------------------------------------- %', n �� Lot Size - -1---�---�--�---�-�--------•---• Garbage Grinder , -------- Number of living units:-r,�---- Number of drooms ___ __ ----- 4 --------------------------------------- --------•-------------------Privato k , Wafter Supply: Public System and name ---- ---------------• Character of soil to a depth of 3 feet- Sand [D Silt F1Claya❑ Peat [:1 Sandy Loam"' Clay Loam ti. (VHardpan E] Adobe ❑..'Fill" ' ter cil ----- ---- If yes,type ------------------------ -- etc. must" be placed on reverse side.) (Plot plan, showing size of lot, biatror)':;of.:_system in relation'to wells, buildings, {: NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within'200 feet,} t Sie' -. i�'G_-L Liquid Depth ------ -------------- K -----•-----.-- h PACKAGE TREATMENT [ SEPTIC TANK x- ; _` No. Compaftrrrents ----477:p '�"� Type ° :- Material__C` C 77: p Distance to nearest: Well ___- _ �--`-----"-- Foundation r_-.1- --------- Prop. Line ___el ------- p .3__.__ Length of each ine_- - 7 9f1 Total Length LEACHING LINE [ No. of Lines ____ ' — --Depthy Filter Material ----_ ------ ------------ ------ 'D' Box --_f--.-- Type Filter Material �-= - - - - ,•£. � r' . Q i------ Foundation ---'_f- -------- Property Line -- ------------------- . --------- Distance to nearest: Well _______ ______ . Depth Diameter ---------------- - ------ Rock Filled Yes No SEEPAGE PIT [ ] p Number,__- ------------- - • - �— Water Table 'Depth --------------- 1_J. '- t_ _Rock Size ---------------------•---•------ l "'t'/moi! }---Foundation -------------- ---- Prop. Line Distance to nearest-..Well ---------------- ------------- - `_.. i w Date ----------------------------------I REPAIR/ADDITION(Prev. Sanitation Permit =------------ Septic Tank (Specify Requirements) ---------- i-- ------- -----=-- - ------------------------------------- =--------------:-- ::.------------------- ----------------------- Disposal Field (Specify-Requirements) --------- s ` -----7--------------`"---- -------------------------------------"-------------------------------•---------- -------- z (Draw existing and required addition on reverse side) I hereby certify that'1 have prepared this application and that the work will`be done in accordance with San Joaquin 7 County Ordinances, State Laws, and Rules a 4 Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, ! shall not employ any person In such manner I as to become subject to Workman's Compensation laws of California." & Signed - = --------- ------------ -------- _-------- -------------------------------- ----- - t ` �a.C.�.. ``•c'� Owner ._ ---�--------------------- . Title ---------- By ------ {!f other than owner FOR EPARTMENT USE ONLY ---fr-- APPLICATION ACCEPTED BY --_ ` ------------------------ DATE _.�� DATE BUILDING PERMIT ISSUED ------=------------------ ---- ADDITIONAL COMMENTS ---------------------------------------------------- --------- ------------------------------------------ ;- ---------------------------------------------------------- --------- - = - gate __f -��--- Final Inspection b T SAN JOAQUIN LOCAL HEALTJ-I DISTRICT F_ H. 9 1-'68 Rev. 5M