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FOR OFFICE USE- - ------------ I ......... ......... -------- APPLICATIOWPOR SANITATION PERMIT Permit No...717.A.-V7 (Complete in Triplicate) This Permit Expires I 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 des.cribed. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: JOB ADDRESS/LOCA7I0 _-....._.CENSUS ------_-------. TRACT --------------_- ---- ............. -------------- Phone Owner's Name ----- ----- /!:�� 6-3---- �LV_ _-2/ ------- ---------------- city Contractor's Name -------------- ------- ---- — ----------------------- ------ Phone VVf;:�A&4 ------ Installation will serve: Residence l)<Apartment House -E] Commercicil.:E]Traller Court C] Motel C] Other .---------------------- ---------- ------ Number of living units: ---------- _ 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 0 Clay 0' Peat El Sandy Loom E] Clay Loam.,'E] Hardpan E] Adobe M. 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 -1 I Size_______________________________________________ Liquid Depth --------------_----------- Capacity : ------------------ Type ........ _---------- Material--------------_--- No. Compartments ............. ........ Distance' to nearest: Well __..______________________________Foundation ---------------------- Prop, Line ----- ------- ........ LEACHING LINE No. of Lines ------------------------ Length of each line-..---__--__.-._--_--..__-_ Total Length ------------ ................. 'D' Box ---------- .- Type Filter Material ---------------_- .-Depth Filter Material ------- ------ ----_------------------- 5 Distance'to nearest: Well ____________________ _ Foundation _ ----------- ..... .-- Property Line -----_------ --------- 0 SEEPAGE PIT Depth -! ----------- ------ Diameter _. .............. .Number --------_------- - -------- Rock Filled Yes 0 No 10 '5 Water Table Depth -------------------- ----------- --------------- Rock Size ------- _-----_--------_---- Distance to nearest- Well ..-__._..-.-__------------------------Foundation .--. ---------- Prop. Line ----_---------------- REPAIR /ADDITION (Prev. Sanitation Perm' 1# -------------------------------------------- Date ------ Jr A ----- Septic Tank (Specify Requirements} _19_! Disposal Field (Specify Requirements) ... ZZ4V ----- --- 0- .......... ------------------------------------------ ------------------------•-------------------------•---------.._......_..-------....--------- ............---...._.._.t-----••-----....--- ---- ------- - ----- -------------------------- .................... :'---__ ----------- Z ----------------------------- - ---------------------------- ... .••-•----...-•-•----- ------------------- - (Draw existing and required addition 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 Son Joaquin Local Health District. Home owner at licen- sed agents signature certifies th4 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 become subject to Workman's Compensation laws of California." Signed ------ ------_------ I ----- Owner T..... ........ --------_- ------------ -------_--------- - ---------------- - By -------- Title . ------------ (If otItY han owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - — ----- ------------- _ -------- ----- ..................... DATE -------------- BUILDINGPERMIT ISSUED ------------------------ - - -------- ---- ----------- --- --- -------------- _ ------ ........ DATE ---.--.--•---------------_------•---- ---------- --- ---------- -------- --------- ........... ............. ............ I .......... ADDITIONAL COMMENTS ------2:n3 -7 — !� - --------- ---------------- - -------------------- ------------------------------- ------------ ------------ ------- -- * --------------- -------- * ------------ -** ---------- ---------------------- --------- Final Inspection by; ---- ------ ----------- ----------------- ------------------ e-7 -,- -'7— 6 - -- -------- ....Date �.� ............... . ------------- ------- ---------------- --- ---- ------- ---------------- -------------- --------- ------------ -- ........................... . --- - ------ ---- --- SAN JOAQUIN LOCAL HEALTH DISTRICT r,r -- E. H. 9 . 1-'6S Rev. 5M