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"FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------------------------------------------- (Complete in Triplicate) Permit No. 7-- -------------- ---------=----------------------------------------------- ------------------------- ----------------------_ This Permit Expires ] Year From Date Issued Date Issued -q:-A=-7 Application is hereby made to the San Joaquin Local 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: JOB ../ Q--M$Z7A*_�__15Q__------- _� �-----------CENSUS TRACT -------------------------- Owner's Name ��LCG�-•--�---------------•-=-------------------------------------------_---------------------Phone'06.4777....... Address ---�f ---�•--- J1:e'1gW e,0,Mk------------------------------------ City G T - -- ------------------------------------- Contractor's Name _ /! -� __ �=------------- License # Z�,S 1.. --- Phone Installation will serve: Residence XApartment House❑ Commercial:❑Trailer Court !❑ Motel ❑Other -------------------------------------------- Number of living units:---/------ Number of bedrooms,_------Garbage Grinder ---je'__--_ Lot Size __Tl _X 44P -------- Water Supply: Public System and name -------------- --------------------------------------------- -------------------------------------------------PrivateX Character of soil to a Idepth of 3 feet: ,. SandSilt❑ Clay Q Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan E] Adobe ❑ Fill Material -------------If yes,type ____________________________ i (Plot plan, showing size of lot,docation of syst,tri in relation to wells, buildings, etc. must be placed on reverse side.) \ NEW INSTALLATION:k (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) �r PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size___= __X_1Q-�_X._6_S`r.--- Liquid Depth ---4�--.5--_ _,.____ Capacity � BEType _ -_�' __ Material____- Compartments ____ -S.____.. Distance to nearest: Well _ _________________________Foundation __lam-- ------ Prop. Line ---15------------ \ [ ] Lines ,__ — Length of. each line _74 Total Length ____/_�iQ___________ LEACHING LINE No, oft Y I __ _`--%=y D' Box -nly:_,Type Filter,Material-__�__,& Depth Filter Material ----I�______._-.______ i - -f { i ---40 Pro . ----- --f------ ,�•;�` Distance to nearest. Well _-___�� _ ____ ___-Foundation party Line -�________________ SEEPAGE PIT [,] , Depth 112-5 ------ ___I Diameter ��_---__ Number ______- ----------------- fled Yes No ❑ Water Table Depth --------�-- -----------------------------RocklSize Distance to nearest: Well ....,l'L9 -------------------------Foundation---/f,------------ Prop. Line __�---.------- REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date _____-__._._____________________-_f I Op a t SepticTank (Specify Requirements) -----------------=-:---------------------------------_------------------------------ ---------------------------------------------------- i Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- -,. --------------------------- ------------------------------------------------------- --------------------------------- ------------------------------------------- 1 (Draw existing and required addition on reverse side) I I hereby certify tht,I have prepared athis application and that the work will be done in accordance with San Joaquin County Orcljnancest 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 t to Workman's.Compe ation lawsg,"alifornio." Signed ------ ---- - ---------------- Owner x By -------- -- ------------ - ----- C =---- - ------ Title ------------- (If er t an owner) , - I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . =- _W- ------------------------------------------------------------------------------------ DATE - ',�`_� _------------------ BUILDING PERMIT ISSUED ----- ---- ------------------------- ---- ------DATE ------------- --------A----------------- ADDITION -- - ADDITIONAL COMMENTS -------- -------- v.--------- f ----------- -- - e ------3_- 7�----------2_a---` -- ------------------------------------- -- --------------------------------------------------------------------------------- ---- --- -- ------------------ - - ------, Final Inspection by: ---------------------------------•-- --------------------------------- Date ?-- ;3� --T- F SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M _