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` FOR OFFICE USE: _ f APPLICATION FOR SANITATION PERMIT . � z-S, _ (Complete in Triplicate) Permit No. 7---_ _-_-- _ Date Issued This permit Expires 1 Year From Date Issued —p 'EO. 7, _ � Application is hereby made to the San Joaquin Local Health District for a per 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/LOCATTION .S.-Uo__ —T__.w`ST---©-------SpReiNc-------R----.-""- TRACT -----------------•-------- : > F 05Co 0WJ/V 323 2 1 7 0 Owner's N me --- --- ------ - - ------------------------------------------------------------- -------------------Phone --- - ---------------------------- Address -& 700. ------------------------ --- Address & 7d0 � W0006u0"-0 Ave -----------------=--------------- ---------- ------------------------------------------------- CitY • Contractor's Name __q 6 SIL EI r Installation will serve: Residence X Apartment House ❑ Commercial ❑Trailer Court ❑ Motel ❑ Other -------------------------------------------- .4CRE AG Number of living units:_________ Number of bedrooms ______..Garbage Grinder ____.__.__._ Lot Size _._---------------------------------------- Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private 52 Character of soil to a depth of 3 feet: Sand'[E Silt❑ Clay ❑ Peat❑ ' Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ 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[ ] Size------------------------ ----------------------- Liquid Depth -.----______.____________- -� Capacity -------------------- Type ---- --------------- Material--------------------- No. Compartments ------------ . - Distance to nearest: Well/Fier ---------------------------'-----Foundation --.-----------___.-- Prop. Line ----------------...... LEACHING LINE [ ] No. of Lines -.._--- Length of each line--------------- ----------- Total Length 'D' Box Taterial --------------;__--.Depth Iter Material -----_--__-__-__________-_---_-__.-... 0Distance to neares _____________----- Foundation _. --------- Property Line ________-_---_-__-._SEEPAGE PIT [ ] Depth -.----.-_.-.__-_ r ---------------- Number . _- ----._----_------__-- Rock Filled Yes ❑ NoWater Table DePt ---------------------------------Rock Size Distance to nearest: Well ----------------------------------- _--_Foundation -------------------- Prop. Line ---------------------- REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------------------------------------------------------.-------------------------- ------ -------------------------------------------------- /9Aoca Ra F, Ire- BC � Disposal Field (Specify Requirements) --------------------------------------- - ---------- -- - ------------ -- -------- ---------------------------- 91r-1--s�- T) `-'6-------- ��ks 7-r-1-- ------------------------------------------------------------------------------------------------------------=---------------------------------- ---------------------------------------------------------- (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 Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Hcen- 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 Workman's Compensation laws of California." l Signed __.. ___. ,� __ __ Owner ----------- - -- --------------------------------------------- fBY ---- ----- ---------------- Title -------------------------------- (If other than her) 3 F DEPARTMENT USE ONLY lei+ APPLICATION ACCEPTED BY ----- = -- - ------------------ ------------------ DATE -- ------- ------------- ----- - --------------------- BUILDING PERMIT ISSUED----------------- ---------------------------------------------------------------------------------------DATE ------------------- - ADDITIONALCOMMENTS -------------------- -----------------------------------------------------------•---------------------------------- ----------------------------------- ------------------------------------------------------- ----------------------- ---------------------------------------------------------------- ------------=------------- ----------------- ---------------------------------------------- Final Inspection by - -------------------------------------------------------Date -- "" - - - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M