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FOJt OFFICE USE: �.. . F9 JZ FOR SANITATION PERMIT Permit No: _7 7---�---,• ----- - - =------------------- ---------- (Complete in Triplicate) - This Permit Expires 1 Year From Date Issued Date issued ----------------------------------------- Application is hereby made to the San Joaquin Loc6l 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- - /V/�-C. - JOB ADDRESS/LOCATION ------ --7 2-5-0--------N--------- --- i U1.��E' ENSUS TRACT Owner's Name rg� ---- ----- __r—.---I---------------(-,- ----------------Phone -�-�- �-- ------- - - - - - Address .uaT' ------------------------------------------------ City �07--e-17-15 Contractor's Name �s(� �� 7------------ j '`' 1 License # Phone Installation will serve: Residence [Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------•- Number of living units ------ Number of bedrooms ___ ____Garbage Grinder ------------ Lot Size -------------------------------------------- W Water Supply: Public System and name ---------- -' -------------------- ----------- ------- - ---------•---------------•-------------------Private Eq-, 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 I ] SEPTIC TANK j ] : Size-----------------------------------•------= Liquid Depth __.� ----.--------- Capacity 120-------- Type (7 4f!Material---------------------- No. Compartments "_2.............. Distance to nearest: Well _J60 -t - __ _"""-- Prop. Line J------ LEACHWG LINE j ] No. of Lines ..__�_______________ Length of each line-_-_A/_0 Total Length"-__�-�_- ?-__..._.__.. N 'r r• 'D' Box �___�_ Type Filter Material -12___'r epth Filter Material ------1,�----------------------•-------- 0` .4 i Distance to nearest: Well _� -_ ______�j_ Foundation _tV 41..______ Property Line ._ 7, SEEPAGE PIT [ ] Depth _�_. --------= Diameter __3____.____ Number -- -.- --- Rock Filled Yes No �❑ Water Table Depth ----_0!--t------------------------Rock Size ---------Mk:-------------- I 0 __?-- -'-__ Prop_ Line -------------- Distance to nearest: We .��___ ll ___ _�"______________________.Foundation r.. REPAIR/ADDITION(Prev. Sanitation Permit# _.------ ----------------------------------- Date --------`--.----------------- f 1 Septic Tank (Specify Requirements) ------------------------------- --------------- --------------- Disposal Field (Specify Requirements) ---------- -------------------------- -------------------------------- ---------- — ------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------- ---------------------. -----------------------------------------------------------.------_-------------- �. : _ __;--- --- - (Draw existing and required addition on reverse side) _ i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin p 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.- "I ollowing:"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 BY (f t.r " Title - L-l.t'1 G. O ^ other than o ner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -- ----- ------------------------------------------ ------------ DATE ------- ----�----- BUILDINGPERMIT ISSUED -------------------------------------------------------------------------------------------=--------------DATE _.------------------------------- ADDITIONAL COMMENTS ------------- --------- ---------- - ----------------------- --------------------------- ----------------------------------------------- ------- ----------------- ------------------------------- ---- - ------- � ------ -- F - --------- ------------- ---------------------------------- , _ - ---- ----- ------• - Da - Final Inspection b 67_ _____________ SAN JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'68 Rev. 5M.