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y R QFFICE USE: --- .... -- ...... --- - APPLICATION FOR SANITATION PERMIT i (Complete In Triplicate) Permit No. .7 "s� -. ........ t This Permit Expires 1 Year From Date Issued Date Issued ......�:.7 ' 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 mode in compliance with County Ordtna ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .0�. G 1_1� .Wa-,e-en!�. ---4-_`1' - - - - �.._.............. ......CENSUS TRACT ......... ....,... Owner's Name L-., ..... .� ••._.-.. Jt :e�'< ! ... Phone . Address ..` .. . .... .. .. ... ——---•-----•-. City Contractor's Name ..... �tl /©h �- _ .......License #4�P. .lv �,fx! '✓ .,�,1'`�... Phone .. .. Installation will serve: `}• ••••.••--..---- Residence,"Apartment Housef] Commercial❑Trailer Court Motel E]Other...................... Number of living units:.. _ - � _ Number of bedrooms ..a2-.--Garbage Grinder ............ Lot Size ... -.?� o2 d D Water Supply: Public System and name .............. �, n / t `......."•'•- &)Q om{,.. Character of soil to a depth of 3 feet: Sand --• ....................................................Private ❑ Silt❑ Clay 0 Peat 0 Sandy Loam 13 Clay Loam Hardpan 0 Adobe V Fill Material ............ If ye:,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 TAMC -' fj Size.....----•.....................•-•--.--•-•------ Liquid Depth .......................... .................... Capacity ------------------- Type ----------•--------- Material...................... No. Compartments _L Distance to nearest: Well ------------------------------------ ��-��"""-"'" -------------•----------------.Foundation ._._.........--....... Prop. Line ...................... LEACHING LINE [ j No. of Lines ..........._---- Length of each line................ ••. --- Total Length Box Type Filter Material ....................Depth Filter Material Distance to nearest: Well ........................ �� ••�•` `•-"�•••--'"""-' Foundation ......-_.. .,_.--- . Property Line SEEPAGE PIT � ........................ [ j Depth -------------------- Diameter Number * . .. . ----- Rock Filled Yes ❑ No C] Water Table Depth --•--------------------- ....................... Size --•............................ Distance to nearest: Well ---- ..................................Foundation .................... REPAIR/ADDITION(Prev. Sanitation Permit# .................. ..-__. Prop. Line .............. Date Septic Tank (Specify Requirements) -------- ---- ) Disposal Field (Specify Requirements) -- ............... -------------- _ -- -- ---------•--- --- .------- V............... ............ ------ ... (Draw existt g and required addition on reverse side} / ............ hereby certify that 1 have prepared this application and that the work will be done in accordance with Son 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, I shall not employ any person in such manner as to bec ub' ct to Wo an'sFl ompensation laws of California." Signed J -- ,�� ----------- ------- ------------------- Owner i other t n owner) ---- ------ Title _.--t%', . FO DE ARTMENT US_E ONLY APPLICATION ACCEPTED 8Y __ -- _V,_/— BUILDING PERMIT ISSUED - - ---- DATE _ S. 7 - ADDITIONAL COMMENTS - --------------- - ------DATE . -- - -- ............ . ...... - . --- .-_ Final Inspection by: ----_---. - _ . .... ....... /1c ' M _—= EH 13 2L 1-68 lieu. 5� ..._....Date SAN JOAQUIN LOCAL HEALTH DISTRICT __ 8/7b 3M