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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 7G /p �� {Complete in Triplicate) ......... .................. This Permit Expires ] Year from Date Issued 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 tomplionce with County Ordinance No. 5,49 and existing Rules and Regulations: JOB ADDRESS/LOCA N ..-_---- _ �i_ -'+f�-- • •---!! Q11�/�J61 .11__... _ . ......................CENSUS TRACT .......................... Owner's Name ... _..... D.1d.�I ✓"l tt1�1�......................•,.............. .,.(. ..........,......Phone Address ` '-�.._>j _5�1 .............. ...........................I................ City ...✓..y/.11.11-7,1.4_7,0j......1.� 4.x.1. _.. p. 1ytJ...l / �d� . 7�� Contractor's Name ----- - Ate/!�ef��`i...........................Lioense .. 1� . phone ...._......- �.._ Installation will serve: Residence Apartment House Commercial ❑Troller Court C Motel ❑Other ............................................ Number of living units:---- Number of bedrooms -ice.--...Garbage Grinder ...- Lot Size ....Ir ............................ Water Supply: Public System and name ....... •.........................................•------......•--...........................................Private ❑ -� Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ NNS Hardpan ❑ Adobe o 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 slde NEW INSTALLATION: (No septic tank or seepage pit permitted If public s wer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK�4 Size......( ----`lr,44._.-___. Liquid Depth ...../ 00 Capacity _. ._.. Type ._.:_ .... Material... . """?` No Compartments ---- .... �..... Distance to nearest: Well ___ --- .:..._,::...........Foundation ___ ............ Prop. Line ...78._........; LEACHING LINE [ ( No. of Lines ___3--------------- Length of each line.------- G............. Total Length ...... ......... D' Box --------- -- Type Filter Material ....................Depth,Filter �lateria) .................... •..... _.. ....._.....,.� Distance to nearest: Well _ .10 . .... ._...... Foundation __:... .._._.__•.. Property Line ,7 ...... SEEPAGE PIT [ 3 Depth -------------------- Diameter .--------------. Number --_----------..---------__-- Rock Filled Yes ❑ No �] Water Table Depth ----- ..........................................Rock Size ......................•---...... Distance to nearest: Well ............................... .......Foundation .................... Prop. Line ...................... REPAIR/ADDITION IPrev. Sanitation Permit# ------.-------.----------------------------- Date .............---------------------) Septic Tank (Specify Requirements) .......................................I------- ...................................--......... ..................-............ .............. 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 done in accordance with San Joaquin County Ordihanco/s, State Lays, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents s gnature c reifies t`e following: "I certify that :n he di rforma ce of the work for which this permit is Issued, I shall not employ any person in such manner as to become su 'ect Wo n's Compensation laws of California." Signed ............ -- - --- --- Owner BY - --------------------- - --------------•_.._ Title --- ---------------- other than owner} F DEPARTM T USE ONLY APPLICATION ACCEPTED BY ----- — --- • •............ ..•- ----------------------- ---------. DATE,��.`��...... ------ iLDING PERMIT ISSUED --•- ----- ------------------ ---DATE _ .........................-.............. ADDITIONAL COMMENTS -------- - ._ ----•----•--------------------------------•-•----........................... _...._ ------------------------ --• •-------.. ..._.._1' ---- Final Inspection b ..... ..................Date ......:.._.---....- ........................ { EH J'3 24 1-68 Rev. 5m SAN JOAQ N LOCAL-,I•IEAkH DISTRICT 8/7h 3M