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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------- Permit No. 7 (Complete in Triplicate) �-- s> !Y 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 described. Thisa plication is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ba / � JOB ADDRESS/LOCATION .---------� -----------� r�/J AxW F LL-- LATfi}RO-P-CENSUS TRACT ------ ----------------- Owner's Name _.._ F11 �L-��r !`JI��t�_ __ �_C _OF . ` Phone Address -------------P-Q_.-..baK----3a-z-----------L..F�T}_?W_1------ City ----------------------------------------------- Contractor's Name . *" ------PR141-t?5_'-------------------`----- -------.License # ---- --------------- Phone ------------------------------ Installation will serve: Residence E-A'ppartment House❑ Commercial ❑Trailer Court i❑ Motel ❑Other -- ----------------------------------------- � Number of living units:---- Number Number of bedrooms ________Garbage Grinder _k_Q___ Lot Size 110Q___ _________________ Water Supply: Public System and name 411THP-P------ '-_VV-`_____________ _Private ❑ Character of soil to a depth of 3 feet; Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam .E] Hardpan 0411- Adobe ❑ Fill Material _/ 0_=_If yes; type (plotplan, showing size of lot, location of system in relation to wells, buildings, etc. must a placed on reverse side.) d; a. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size_3_-X tO__X_ 5_1----------- ___ Liquid Depth _ /�......__...__ .; Capacity A0.0 0:t Type evR -- Material_ d. -`__-- No. Compartments -----7�;=--:---- \\� Distance to nearest: Well ______ a-_�_______________Fouhdation- _10--------_---- Prop,. Line,-------------- LEACHING ;__ e_�---a-y--- LEACHING LINE No. of Lines ------ ----2 ._--- - - g eachiine --75---r---------- Total Length -----Y --------r ------- 'D1 ------ 'D' Box J Type Filter Material aC-- eD�pth _ Filter Material -------- : - '-- 4 Distance fo-nearesf: Well"_: =_: FaundatiW `---/0"�J"'�_""-"-Property Line ______ __ SEEPAGE PIT [ ) Depth _____ ------- _ Diameter ,,____-__;___---_,Number :-: __.___ __._________ Rock Filled Yes No 0 I • ; , Water Table Depth ------------------------------------------- ----Rock Size ---------------------------` 3 ; - Distance to nearest: Well -----------------------------------------Foundation ----------..-------- Prop. Line __#_____-______..__.. REPAIR/ADDITION IPrev,:Sanitation Permit# -------------------------------------------- Date ---------------------------------_) Septic Tank (Specify Requirements) -------------------- --------------------- ----------------- t Disposal Field (Specify Requirements) ----------------------- ---- ----------- ----------------- -------------------- -------------------------------------------------------------------------------'---------------------- ------------------------------------------------- ----------------------------- ------' i (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,rLaws, 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 workforwhich this permit is issued, I shall not employ any person in such manner as to become su ct t rni p upt' n laws of California." Signed --' "- - - - ------ -- Owner By --------------------------- - ---- - ------- Title ----------------- (If other than owner) FOR_QEPARTMENT USE ON4Y__ ._.7._ APPLICATION ACCEPTED BY --------- --- - --------- DATE -----� ?q.` --------- BUILp1NG`PERMIT`ISSL')ED'.�_ __---_----___,..—_-_-- . _ ._ _.__ m� T .,._..�... . . ._,,._._.___. _ . � ,_._. .._ . ADDITIONALCOMMENTS --------- -- ---------------------- - ----------------------------------- ---=------------------------ ----------------- ------- _ - - -------------- + Final Inspec -----------------------------Date --- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev: 5M �'