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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ------I......... Permit No. .._7 ..... (Complete in Triplicate) / ......................................................._.___. Date issued .�1..�.7 . . ... This Permit Expires ] Year From bate Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and 'install the work herein iI described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: ! :: . 1. .... ••...... ... TRACT JOB ADDRESS/LOCATION .._....,...-----. --.....---- . .�. ry Phone /. . . Owner's Name �•��r Address ------..--...... Ur I •_-----.E-7.3..................................•-•......... City •-----eVACT ............................................. Phone Contractor's Name _.........../aa-��.-. 4� __....._.. License # r � '. .. �'. Installation will serve: Residence Apartment House 0 Commercial ❑Trailer Court 0 � t t p Motel ❑Other ........................•. •••--• .......... e.- Number Number of living units:...____... Number of bedrooms •....Garbage Grinder ......... Lot Size ...... .... __.._.....•...................� Water Supply: Public System and name ------- ........ _.,..:.w_. ................ -�:."--------------------------------------------- Cloy : -- ----:-- --r- •------------- Private�' _ ... ................ ... .. ... 3 Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay [] Peat❑ Sandy Loam {� Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill Ma#aria) ...._......_ If yes,types__...---.-:----......_ ------ D (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. mush be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ j SEPTIC TANK ] ................... Liquid Liquid Depth ....fi'. _..---••_-.._. i Capacity Type Material...................... No. Compartments .....:Z............ j � P Distance to nearest; Well .. ._Foundation ../�'.......:........ Prop. Line ...;: LEACHING LINE I No. of Lines ....... Length of each line..... _)_�._..._....: Tdtal Length ... `�� ._...... /moi, Depth Filter Material ,�/J�--.--•....................... D' Bax ....f...... Type,Filter Material .� Xr �-D p Distance to nearest: Well .,JL?..?......--..•--. Foundation.. ._-_f. .............. Pro perty Line ��----•--..• SEEPAGE PIT [ Depth ---.....-•--.....--- Diameter ................ Numbe�......................... Rock Filled Yes [3 No ] �... j -•---. Water Table Depth .......................................:........Rock Size ••--_.- 3I Distance to nearest. Well ........ _.._....._3 Prop. Line ..................... ............................... •' I REPAIR/ADDITION(Prev. Sanitation Permit+ .................. Date .......................... ....... Septic Tank (Specify Requirements) .................------------------------------------------------ ..................--•-•--.•---•--••.... _...--------7--------------- .. Disposal Field (Specify Requirements) ............... { .... .......................•-•--......I......__..__....._..... ---•-••........ ......•----•...- ,K.._.._...1—. .._�.... _... s (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 in accordance with San Joaquin County Ordinances, ':State Laws, and Rules aril Reg u0—iins of fhe_San-J -' ,Local Health District. Home owner or Iiceit- sed agents signature certifies the following: "I certify that in the performance of the work far which this prat is issued, I shall not employ any person in such matinee laws of California.",-� Signed ...... •Owner k astobecom�iub�t�orkm n s Com ensat an ..•--•--.1.•--••.--•-� -1- ii. l Title ........ Ilf other than owner) i, t i I� . R DEPARTMENY USE i ONLY - . A/— 3-�% APPLICATION ACCEPTED BY A.of ....•-=............................... DATE .....-••--.......-•---...-- .... BUILDING-PERMIT`ISWED� .'-:...I.............................z__ _� ._. ._-. . ........ ---- BUILDING ADDITIONAL COMMENTS .... ......---•..................•--.........: .......................................................•••-•-•••-•. ......•--- ........................F ......... ...................................:..................•--------. ...........----•-•---....'. ._... ......... ........... ..........----- ........,... ........ ..•-••--........ :..... F .............. Final Inspection by: �.. ::. ...... ..Date _-- ..`. :-•• .. SAN JOAQUIN LOCAL' HEALTH DISTRICT i 7/72 3 X