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LFO FFICE USE: APPUCATION FOR SANITATION PERMIT � 7� - Permit No. -----7------- - --- ��` (Complete in Tript icatel Date Issued-------------------- --------------- This Permit Expires 1 Year From Date esus l the work ruct and Application is hereby made to the San Joaquin Local with Health DytOrdinance permit and ex sting Rulestalnd Regulationsrem pp .: ��Y ,�. described. This application is made in compliance q� , I � .- _7. -. ---- ��----n--�-�=--�0----,<---��•-�� y.,-.-CENSUS TRACT ----------------------•--- JOB ADDRESSAOCATION ._-= _ Phone -�.D-R -_^ ---- CAL-0 3 - Owner's Name ..- - -- ------------ ----- ----------- City .1{_ _a Address ----- "4-E-. ._ Phone 1� i � --- - -- -- -- -- - -�-- ---License # -�-7. -�g-�- �_�-�- Contractor's Name -.---�-��5- ---� j installation will serve: Residence ❑Apartment House'El Commercial :❑Trailer Court '❑ I Motel ❑other ------------------------------- ----------- N• Lot Size ----�--- -------- -- ---- -----•-- --- -- Number of living units:--_.�_----- Number of bedrooms --,A-----Garbage Grinder .�---- -------- - --------- - ------------------------------------------ ------------Private Peat❑ Sandy Loam Water Supply: Public System and name .__-------------- ---•--- Clay Loam :� Character of soil to a depth of 3 feet: Sand'El Silt❑ Clay ❑ yes,type --__.--__------------------ Hardpan E] Adobe ❑ Fill Material If laced on reverse side.) } (Plot plan, showing size of lot, location of system in relation to wells, buildings, avacilable wthin 2d0 feet,) y; NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Size---q4-CR--X-15-q.,----------------- Liquid Depth ..-,5------------------ PACKAGE TREATMENT [ ] SEPTIC TANK [�3 �No. Compartments -c�..----------•---- i nRECAS "Material- Ql tom' - CapacitY / Type L Distance to nearest: Well _-->��-------------------------Foundation .-10-.._._.---- Prop. Line --- ---=-• 1-9--------------------- � Na. of Lines -----.�------ ----- Length of each line..- -� - _ ---- ---terial ---- 9 •------•- / Total ten th i LEACHING LINE IV] De th Filter Ma er Line 'D' Box .��5- Type Filter Material ./�Q_C/C----- p .1 f Foundation _..1Q------- ----- Property t Distance to nearest: Well __.4JQ------------- + Rock Filed Yes ❑ No Q❑ Diameter ----- Number ------------ SEEPAGE [ ) Depth --- - -----Rock Size---------'----------- ------ ----- Water Table Depth l --------------------- Distance to nearest: Well -------------------- ---Foundation -------------------- Prop. Line --- •-•---• ' ----------------------- ------ -- -Date - ------------ ------------------) . G REPAIR/ADDITION(Prev. Sanitation Permit# -------- r --------- Septic Tank (Specify Requirements) _-------- ----- -- ---------- ------------------------------------ Disposal Field (specify Requirements) ----------------------------------------------- __________ ______ --------------------------------- t -------- ---- - - - - --- ------ ---- - ------------- - -------------------------- (Draw existin 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 t 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: erson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any p as to beco subject to Wor anIs Compensation laws of California." Signed - ------------------ Owner --------------------------- ----------- ----- ------------- ----------- • it e ------------ (If other than owner)', FOR DEPARTMENT USE ONLY DATE ------ ----------------- APPLICATION ACCEPTED BY.------------- --+---- ' -- -----------DATE .. BUILDING PERMIT ISSUED ------------------------ ADDITIONAL COMMENTS ---?-" 'J -7 ------------------------------------ --- ------------------------------------------------------- ------------------------- ''_ -------------------------- ----------------- =- ----------------- Date . ." ._ .. Final Inspection by: ---Lit---- ----------<ff" = SAN JOAQUrN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M '