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FOR OFFICE USE: ----------- APPLICATIONFOR iSANITATION PERMIT u} Permit No:7-Q_ 7 ?/ kN (Complete in Triplicate) 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. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION -------- 51 Q 9 �3"f -%� ` ---------CENSUS TRACT Owner's Name .- i �� 8_G�A-1y!A-C---/ � -------- ! - Phone __ 3� ✓�'f----------- Address ------ ---- IJ -1`l q�--------I------------------------------------------------- City ---- � Z Contractor's Name --------- Fc-f/"Qy---------------------------------------------License 76-- Phone ------------------------------ Installation will serve: Residence ❑ Apartment House❑ Commercial railer Court i❑ ^`I IMotel ❑Other -------------------------------------------- Number -- -- -Number of living units------------- Number of bedrooms ------------Garbage Grinder ------------ Lot Size 1-7-�-7-4-1 --------------•---- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private Character of soil to a depth of 3 feet: Sand[] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ AdobeX1 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.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [_],_„SEPTIC TANK-'{: �C•osT ----------------- uidp Depth_.__ ."" :---. --. r' Ca acit T e :--- -""""-- Material-_--""-- i P Y �Iv YP --- ------ -No.'Corri artments __ __---_. Distance to nearest: Well _.___/�_______________________Foundation __4Q--____--__-- Prop. Line ._ �.i__ ------ Q ; s I �- __ Total Len ------ "- G 4 LINE [ ] No. of Lines _____f-------------_ Length of each 'D' _-- "��----- Length --------- LEACHING t 'D' Box ____/__.____ Type Filter Material ___f _ Depth FilterMaterial ------------ ------- ________ j - - jDistance to nearest: Well _____F1.4_-`,--________ Foundation ______________ Property, Line_ ------"""-""-. --• i 4 I SEEPAGE PIT [ ] 1 Depth ____________ _ _____ Diameter ---------------- Number ---------------------------- Rock Filled • Yes '❑ No 0 - L Water Table Depth --------------_-= --- -__--_-______--=_Rock Size,-.-.- s Distance to'nearest: Well ----------------------------------------Foundation -------------------- Prop. Line .. --- -------?-------- I I '' �. REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------� ---------------- Date ----------------------------------1 r l� - L SepticTank (Specify Requirement s] ------------------------------------------------------------------------------------------------------ --------- -------- ----------- Disposal ------- -Disposal Field (Specify Requirements) ----------- ----------- ---------------------------------------------------------------------------------.-- - _ �? :1 C--� _dt. �T.�y� r -.-..�.....-.,______ -_ .. --- -------------------------------------- - - ------- ---------------- --------------------------------------------------- 9 (Draw existing and required addition on reverse side] I I hereby certify that I have prepared this application and that the work will be done,.Lj,_ac.. ,, it ce with San Joaquin County Ordinances, State Laws, and 'Rules and'SRegulcitions of;'the San Joaquin Local Health District. Home owner 6r`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 rkma 's Com sahion laws of California." -, I Signed`.--------�4� r ----- Owner By Title __ �{{ (If other than owner ' O D ARTMENT ONLY APPLICATION ACCEPTED BY -------------- ------- --- --- - --- -------------- DATE __ �'�? BUILDING"PERMIT-ISSL'iED-- -- ---7---- �' ._ ...- .-..--------.�-=- . _ ,.--- --------- ADDITIONALCOMMENTS --- ---------------------------- * `=1:'--'.---- ----------------- ------------='" - ------------- ------------------ ------------------------------------ ----------------- ` -------------------------------------------------------------------------------------------- -----------------------------------------------------------------ti-------------------- - `, } - �" tl` -------------------------- __________________________________________________ ___ _ _______________-__-______________.-----_____________________------___________ Final Inspection by Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M