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FOR.OFFICE USE: LO`APPLICATION FOR SANITATION PERMIT 7 ------------------ ------ Permit No. --- _— L -- 1- ' (Complete in Triplicate) ' ----------I-------- ------------------------------- Y �g3 -----------------------------------------_---------___ Date Issued- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance.with County Ordinance No. 549 and existing Rules and Regulations: fCENSUS TRACT ----------------------.---- JOB ADDRESS/LOCATION ._V_��--- :-- �T `Y� --------------- Owner's Name --------_�- /- ---------------------------------------------------------------Phone -------------------------- --------- Address - - .- ----- AT - ------------------ --- ------------ Cit Contractor's Name -- `C - e..... ` ' License #0797. 9-- PhoneI . �- Installation will serve: Residence ❑ Apartment House❑ Commercial Trailer Court ❑ j Motel ❑ Other -------------------------------------------- r � Number of living units:__~"-'------ Number of bedrooms ____Garbage Grinder _-.--------- Lot Size MY.c_!�?A-------------------- Water Supply: Public System and name --------------- ---------------------------------------------------------------------------------------------•Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ SandX Loam 0 Clay Loam ❑ aterial ____-._--__ If yes, type ____________________________ Hardpan EJ Adobe Fill M (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,j PACKAGE TREATMENT j I SEPTIC TANK'( :Size- - -`]-�X --------------------- Liquid Depth -4r-------------------- © LTypeM � . Compartments ___________ateriaCapacity` Q f / Distance to nearest. Well r_f1Q-- __________Foundation ...At ----------- Prop. Line �~--------------(Q LEACHING LINE No. of Lines ------,�---'---____-- Length of each'.-line----�Q. _____.------- Total Length �.��_-• _----•_-•_ 6 ld /r . 'D' Box/- �__ Type Filter Material __, ��--Depth Filter Material _If,-------------------- --------- ------ Foundation ----- __ Distance to nearest:-Well _ _ _�___-__ p__......... Property Line -37--------s----------- SEEPAGE P1T [ .]' Depth__ . -----------------__ Diameter ------ -------- Number ---------------------- E] C]---- Rock Filled Yes No .,, ' Water Table Depth ----------------------------------- ------------Rock Size ---------- --------------------- Distonce to nearest: Well ----------------------------------------Foundation -----------------.__ Prop. Line _---------- ...... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) 9 Septic Tank (Specify Requirements) ---------.-'------------------------ Disposal Field (Specify Requirements) f . '---------------------------------------- ------------------------------------------------------------------------------- � 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 Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or Been- sed agents signature certifies the following: ; "I certify that in the performance of the work for which this permit is issued, II-shall not employ any person in such manner as to become subject to Workman's Compensatto laws of California." Signed ---- ------ - -------------- - -------------- Owner ---- ---- Title ----eo./ It � --------------- BY ; (if other.than o r) i R DEPARTMENT USE I ONLY APPLICATION ACCEPTED BY DATE _71-011-73 BUILDENG-PIrRMIT ISSUED _. r�---_:___ =-_ ---== --- -----------------DATE...<_ ------------------------------ AD ] ON�yAL C E NTS -- ------------ = - 1 i / ----- ------ ---�Y_r'e--�to_r �� . ------------- ------ -- - ------ - ------------------------------ - - -- --------- Final --- -- - -- - Final Inspection by: -_ --------------------------------------------Date JUIN LOCAL HEALTH DISTRICT 1I. 9 1-'68 R