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-FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No. 7/-7 (P/� -------------------------------- --------- --- (Complete in Triplicate) C� ----- -------------------------------------------------- (J � . ' �- Date Issued --------------------------------------- This Permit Expires 1 Year From Date Issued , Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...... -- - ---- -- ------------------ --------------CENSUS TRACT -_------------------------ Owner's Name -- -------- -- - - -------------------------------------------- Phone ----------------- - Address ------- �-7 �lsu s -----•--- City ---- - - --------- -- - --------------- Contractor's Name --- - License # --C ?-S�r Phone Installation will serve: Residenc4Apartment House,❑ Commercial ❑Trailer Court `,❑ Motel ❑Other -------------------------------------------- Number of living units------ Number of bedrooms ---..Garb Grind X� � Lot Size - ------- -- Water Supply: Public System and name T - ------------ -- ------------------- ----------------- Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam( 'a -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.) sewer NEW INSTALLATION: (No septic tank..or seepage pit permitted if public sewer is available within 200 feet,] f �� PACKAGE TREATMENT [ ] SEPT/IC TAMC' Size--,--05--X-g Liquid Depth --- -------------- Capacity ---------- Ca acifi 6 Z� P Y - �- '�Ype '`-"'"r-'----- Material__�>��-� No. Compartments _____________________ Distance to nearest: Well ------------------------'------------Foundation _--- ------------ Prop. Line __---- e LEACH WG LINE � No. of Lines ------aZ------------- Length of each line__S4"---$:.-fid_,__ Total Length ,-____._------------------- r� 'D' Box "----✓Type Filter Material Zr :_--.Depth Filter Material _/49-------------------------------------- r � Distance to' nearest: Well ------- --------------. Foundation ---ld '-_------ Property Line -_�--------------- SEEPAGE PIT [ ] Depth AQ-------------- Diameter _ ----- Number ------.-----................. Rock Filled Yes No (I _SU X4 Q p��/S Water Table Depth ----------------------------•-•---A Rock Size Y_X �---__-- � Distance to nearest: Well ----.--_""_______ _---------Foundatio �d�f'_--- Prop. Line -..�►'�+.....-____-- REPAIR/ADDITION(Prev. Sanitation Permit# _---_-_------1� ---- -3-6------- Date ----�'/a /7� } Septic Tank (Specify Requirements) ------------------- --------- ----------------- ---------------------------------------------------------------- ---- Disposal Field (Specify Requirements) -------------------------------------- € ------------------------------------------- -• ------------------------------- - ---------------------- ---------------------------------------------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side);__ - ,. _ ,q— ,4„ 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 licen- 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 become subject to Workman's Compensation laws of California." Signed ----------- ----------------- Al"� Title ------`--- -- ------ -------------------------------------------- By (If other n owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY QA7Ef � -------- - --- - BUILDING PERMIT ISSUED -------------- - - ------------------------------------DATE ----- ------------------------------------- - ---------------------------------- ADDITIONAL COMMENTS ------------------------- ------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ --------- --- - D ------ -- --- - Final Inspection by: ate r-- ---- --------- Final LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M