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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _-7--�"-y3 (Complete in Triplicate) - - ------ - -- Date Issued This Permit Expires 1 Year From Date Issued IT 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 Ordinances No. 549 and existing Rules and Regulations: f /I -"4 - ----------CENSUS TRACT -------------------------- JOB ADDRESS/'LOCATION .__/_ �------------------� g*� j�+ Owner's Name -- � '----------------------- Phon �J_=..Q_/ '/31 Address ` � City d7-5C7 �~ Phone Contractor's Name ------License # 17-7 Installation will serve: Residence House Commercial oTrailer Court `❑ IMotel ❑ Other -------------------------------------------- Number of living units:--_ __.___�'Number of bedrooms _____Garbo a Grinder -1V0--- Lot Size ---7� �_+ - ---------- Water Supply: Public System and name ___� ----------------- e-� ivate ❑ Character of soil to a depth of 3,feet: _ Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑F AdobeX Fill Material ---------__ If yes,type ---------------------------- (Plot plan, showing size of lot,Ilocation' 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 [ I SEPTIC TANK, Size------ - -a-- ----- Liquid Depth _fes_!______----- ----- i .I � No. Com artments - �Q T e/ ��' ' Materia .rp ------------- Capacity -- - ----- - Yp y,s. -- ----- Pro Distance to nearest: Wel! ______ _ _____________Foundation __ _.1Q. _ ___ p. Line ___....__ �. LEACHING LINE �j�], No. of.-Lines -------/--------------- Length of each line___�� -�---- ------ Total Lengthy. .r--------• ( 'D' Box1,N0_ Type Filter Material _/6:��r -Depth Filter Material ___ ----------------------•-�----- Distance to nearest: Well ------------------------ Foundation ------/�f----- --- Property line --- ____._....__ SEEPAGE PIT [ Depth ' __ --- Diameter /r Number _______ ___ _A/ Roc Filled Yes No ❑ :1 1/ � Water Table Depth _ ------------- Rock Size Distance to nearest: Well ._�R_____________________________Foundation __��_�______ Prop. Line __,�._-.---__._.. ;F REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------------- ------------- ---- -----------------------•--- w Disposal Field (Specify Requirements) •------------------------------- ---------------- -------------------------------- - ---------------------- ------------------------------------------------------------------------ -------------- -----------------------------------; ----------------------------------------------------- ----------------- ----•------------- ------------- --------------------------------------------- ,- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be dome in accordance with San Joaquin 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: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner ` as to become subje/than man's Compensate n laws of California." Signed ------------------- --- - - ------------------ ----- ------- ------------------ Owner - ------------------ Title ry ------------------- (If ofwner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -;' - ------------ DATE BUILDING PERMIT ISSUED ---- ' - --------------------- ----------------- DATE ADDITIONAL COMMENTS _.__ 4f G-,----� - --- ------------------------------------------------ ---------------------------------------------- f �-- `------------- -- --- --------- -- ------- ----- - ------ ------------------- ------------------ - - -------------------------------- --------- ----------- ------- --- --------------------------------------------- ---------------------------------- ---------- ------ -- ------- ---- ---------------- --- - - Final Inspection by: --- ---------- --------.Date . -- SAN.-JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M